Provider Demographics
NPI:1255423992
Name:CLIFTON, MARVIN DEMENTREOUS (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:DEMENTREOUS
Last Name:CLIFTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4884 CONSTITUTION AVE
Mailing Address - Street 2:STE 1E
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3324
Mailing Address - Country:US
Mailing Address - Phone:225-923-1621
Mailing Address - Fax:225-923-1623
Practice Address - Street 1:4884 CONSTITUTION AVE
Practice Address - Street 2:STE 1E
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3324
Practice Address - Country:US
Practice Address - Phone:225-923-1621
Practice Address - Fax:225-923-1623
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05469R207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery