Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 13429 | HI |
NPI | 1003834086 |
---|---|
Provider Name | Dr. Mark Andrew Clifford |
First Address | Fairbanks, AK 99701-4803 |
Second Address | Fairbanks, AK 99701-4803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 13/02/2013 |