Provider Demographics
NPI:1104096551
Name:WATT, CLIFTON (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:
Last Name:WATT
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 1:3100 SAN PABLO AVE.
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702
Mailing Address - Country:US
Mailing Address - Phone:510-985-5200
Mailing Address - Fax:510-985-5282
Practice Address - Street 1:3100 SAN PABLO AVE.
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702
Practice Address - Country:US
Practice Address - Phone:510-985-5200
Practice Address - Fax:510-985-5282
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101950207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine