Provider Demographics
NPI:1366554743
Name:CLIFTON, CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:CLIFTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-0596
Mailing Address - Country:US
Mailing Address - Phone:501-679-4030
Mailing Address - Fax:501-679-4037
Practice Address - Street 1:55A SOUTH BROADVIEW
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9475
Practice Address - Country:US
Practice Address - Phone:501-679-4030
Practice Address - Fax:501-679-4037
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7658207Q00000X
ARC7608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR13149000000OtherQUAL CHOICE
710781138OtherTAX ID
AR115622001Medicaid
E02941Medicare UPIN
AR115622001Medicaid