Provider Demographics
NPI:1215929799
Name:MARR, CLIFFORD (MD)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:
Last Name:MARR
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:P.O. BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:916-736-6798
Practice Address - Street 1:5275 F ST
Practice Address - Street 2:STE 3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3225
Practice Address - Country:US
Practice Address - Phone:916-733-6050
Practice Address - Fax:916-733-6051
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG457732086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G457730Medicaid
CA00G457730Medicaid
CAZZZ00671ZMedicare ID - Type Unspecified