Clifford P Clark III, M.D., P.A.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

ME0065670 Issued in FL

Practice address

701 W Morse Blvd
Winter Park, FL 32789-3731

Phone

(407) 629-5555

Fax

(407) 629-4884

NPI assigned

Oct 23, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine, Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clifford P Clark MD P a

  • Plastic Surgery Physician
  • Winter Park, FL
  • NPI 1891219614
  Authorized official Same address or phone
• Center for Plastic & Reconstructive Surgery a Professional Association

  • Plastic and Reconstructive Surgery Physician
  • Orlando, FL
  • NPI 1902844038
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770666729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W MORSE BLVD",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327893731",
            "telephone_number": "407-629-5555",
            "fax_number": "407-629-4884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W MORSE BLVD",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327893731",
            "telephone_number": "407-629-5555",
            "fax_number": "407-629-4884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CLIFFORD",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D., P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "FL",
            "license": "ME0065670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Kathleen Ciccarello, DNP
• Ryan Ciesielski, DPT
• Genevieve Cintron, M.A., CCC-SLP
• City of Winter Park (Winter Park Fire Rescue Department)
• Joa Macnalie Claircius, EDD
• Kristen J. Clark, P.A.
• Patricia A Clark, PSY.D.
• Rose L Clark
• Sheena Tooley Clark, LCSW
• Janelle Clarke

• Plastic Surgery Physician in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Plastic Surgery Physician in Florida

• 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.

Verify at the official NPI Registry.