Healthcare Provider Details

I. General information

NPI: 1194380196
Provider Name (Legal Business Name): CLIFTON RUPERT JENKINS HOUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CLIFTON RUPERT JENKINS-HOUK

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

96 JONATHAN LUCAS ST
CHARLESTON SC
29425-8900
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-7031
  • Fax: 843-876-1220
Mailing address:
  • Phone: 843-792-7031
  • Fax: 843-876-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number96820
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: