Healthcare Provider Details

I. General information

NPI: 1043544653
Provider Name (Legal Business Name): KLIFFORD ALEXANDER ROCUTS MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST BI-2144
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

680 CRANE CREEK DR UNIT 1031
AUGUSTA GA
30907-3075
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3873
  • Fax:
Mailing address:
  • Phone: 857-272-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number76154
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: