Active NPI
Clifton Paul Titcomb Jr., M.D.
- Internal Medicine Physician
- Fort Wayne, IN
National Provider Identifier
1437360526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 01040200A
- Practice address
- 4514 Scotia Dr
Fort Wayne, IN 46814-9781 - Phone
- (260) 625-6869
- NPI assigned
- May 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 01040200A | IN | Primary |
Addresses
Primary practice location
4514 Scotia Dr
Fort Wayne, IN 46814-9781
Mailing address
4514 Scotia Dr
Fort Wayne, IN 46814-9781
Phone (260) 625-6869
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01040200A | IN | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437360526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4514 SCOTIA DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468149781",
"telephone_number": "260-625-6869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4514 SCOTIA DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468149781",
"telephone_number": "260-625-6869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TITCOMB",
"first_name": "CLIFTON",
"middle_name": "PAUL",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IN",
"license": "01040200A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.