Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | JC025308 | MI |
NPI | 1124092499 |
---|---|
Provider Name | James D Clifford |
First Address | Lexington, KY 40513 |
Second Address | Lexington, KY 40513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 18/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104288475 | (05) | MI |
A76673 | (02) | MI |