Provider Demographics
NPI:1053379198
Name:CLIFFORD, STEPHEN J (MD,)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:JAMES
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1490 NE 103RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2626
Mailing Address - Country:US
Mailing Address - Phone:305-335-0061
Mailing Address - Fax:
Practice Address - Street 1:1490 NE 103RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2626
Practice Address - Country:US
Practice Address - Phone:305-335-0061
Practice Address - Fax:305-891-6589
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038690207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
96184ZMedicare PIN
FLD63764Medicare UPIN