Provider Demographics
NPI:1427052331
Name:SHARE, CLIFFORD NEIL (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:NEIL
Last Name:SHARE
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 1:741 DUNLAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9226
Mailing Address - Country:US
Mailing Address - Phone:386-761-6665
Mailing Address - Fax:386-760-2369
Practice Address - Street 1:741 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9226
Practice Address - Country:US
Practice Address - Phone:386-761-6665
Practice Address - Fax:386-760-2369
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0031647207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039348700Medicaid
FLD57673Medicare UPIN
FL64428Medicare ID - Type Unspecified