Provider Demographics
NPI:1154879435
Name:YVETTE CLIFFORD, MD.,PA
Entity type:Organization
Organization Name:YVETTE CLIFFORD, MD.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-563-7333
Mailing Address - Street 1:2008 CHILDRESS DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5179
Mailing Address - Country:US
Mailing Address - Phone:469-563-7333
Mailing Address - Fax:214-481-7238
Practice Address - Street 1:2008 CHILDRESS DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-5179
Practice Address - Country:US
Practice Address - Phone:469-563-7333
Practice Address - Fax:214-481-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6380174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ6380OtherMEDICAL LICENSE