Clinton Grover Wolboldt, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

K4298 Issued in TX

Practice address

7601 Quaker Ave
Lubbock, TX 79424-3360

Phone

(806) 725-9603

Fax

(806) 725-9500

NPI assigned

Apr 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320019200000",
    "number": "1851354567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3420 22ND PL",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101314",
            "telephone_number": "806-725-5844",
            "fax_number": "806-723-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 QUAKER AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794243360",
            "telephone_number": "806-725-9603",
            "fax_number": "806-725-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLBOLDT",
        "first_name": "CLINTON",
        "middle_name": "GROVER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2011-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K4298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28801385",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111857209",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080168552",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madilyn Jewel Wittie
• Wittman Optometry PA
• Cathy Y Wittman, OD
• Wnshields Lonestar LLC
• Helena Rebecca Wojciechowski, MD
• Benjamin Matthew Wolcott, M.D.
• Joseph John Wolcott, M.D.
• Randall D. Wolcott, M.D.
• Roger James Wolcott, M.D.
• Eleni Girma Woldearegay, MD

• Family Medicine Physician in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; 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.