MEDICARE: MR. CLINTON AMOS MEDBERY III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	16840	OK

General Provider Information

NPI Number	:	1609873421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLINTON AMOS MEDBERY III M.D.

Provider Business Mailing Address
First Line	:	535 WAMPLER DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-9176
Country	:	US
Telephone Number	:	405-210-7471
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 WAMPLER DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-9176
Country	:	US
Telephone Number	:	405-210-7471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/17/2020

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