Healthcare Provider Details

I. General information

NPI: 1043587629
Provider Name (Legal Business Name): CLIFTON L HESTER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2011
Last Update Date: 11/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E LEAKE ST
CLINTON MS
39056-4300
US

IV. Provider business mailing address

607 E LEAKE ST
CLINTON MS
39056-4300
US

V. Phone/Fax

Practice location:
  • Phone: 601-924-7153
  • Fax: 601-924-9548
Mailing address:
  • Phone: 601-924-7153
  • Fax: 601-924-9548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number03737
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: