Provider Demographics
NPI:1992766455
Name:WHITESELL, CLIFTON LOUIS (MD)
Entity type:Individual
Prefix:
First Name:CLIFTON
Middle Name:LOUIS
Last Name:WHITESELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:500 E ROBINSON ST
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6697
Mailing Address - Country:US
Mailing Address - Phone:405-360-9966
Mailing Address - Fax:405-360-9905
Practice Address - Street 1:500 E ROBINSON ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6697
Practice Address - Country:US
Practice Address - Phone:405-360-9966
Practice Address - Fax:405-360-9905
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK13245208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100095640AMedicaid