Provider Demographics
NPI:1699660134
Name:PRIMEAUX, CLINTON ALBERT
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:ALBERT
Last Name:PRIMEAUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 HIGHWAY 177
Mailing Address - Street 2:
Mailing Address - City:RED ROCK
Mailing Address - State:OK
Mailing Address - Zip Code:74651-0348
Mailing Address - Country:US
Mailing Address - Phone:580-723-4466
Mailing Address - Fax:
Practice Address - Street 1:8151 HIGHWAY 177
Practice Address - Street 2:
Practice Address - City:RED ROCK
Practice Address - State:OK
Practice Address - Zip Code:74651-0348
Practice Address - Country:US
Practice Address - Phone:580-723-4466
Practice Address - Fax:657-375-8606
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist