Basic Information
| Provider Information | |||||||||
| NPI: | 1063467132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLIFTON | ||||||||
| FirstName: | BOBBY | ||||||||
| MiddleName: | GLENN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162255 | ||||||||
| FaxNumber: | 3367163202 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 E GROVER ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281503917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044873000 | ||||||||
| FaxNumber: | 7044767416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 9300668 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 9300668 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4597856 | 01 | NC | AETNA | OTHER | 23083 | 01 | NC | BCBSNC | OTHER | 85328 | 01 | NC | MEDCOST | OTHER | 7279095001 | 01 | NC | CIGNA | OTHER | 8923083 | 05 | NC | MEDICAID | N00661 | 05 | SC | MEDICAID | 050046483 | 01 | NC | RAILROAD MEDICARE | OTHER |