Healthcare Provider Details

I. General information

NPI: 1528041787
Provider Name (Legal Business Name): CLIFTON MAC GREGOR WOODFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 KOHLER MEMORIAL DR
SHEBOYGAN WI
53081-3129
US

IV. Provider business mailing address

2414 KOHLER MEMORIAL DR
SHEBOYGAN WI
53081-3129
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-4461
  • Fax: 920-459-1483
Mailing address:
  • Phone: 920-457-4461
  • Fax: 920-459-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55998-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: