Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 285601 | NY |
Y | 111NI0900X | Internist | 285601 | NY |
N | 207RG0300X | Geriatric Medicine | 285601 | NY |
NPI | 1063852028 |
---|---|
Provider Name | Dr. Vernon Charl Clifton |
First Address | North Tonawanda, NY 14120-2019 |
Second Address | Buffalo, NY 14215-3021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2013 |
Last Update Date | 12/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04875370 | (05) | NY |