MEDICARE: DR. CLIFTON WOODS MD

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	207Y00000X	Otolaryngology Physician	T4607	TX

General Provider Information

NPI Number	:	1710417456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFTON WOODS MD

Provider Business Mailing Address
First Line	:	400 W IH 635 FWY STE 360
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-3764
Country	:	US
Telephone Number	:	972-402-8404
Fax Number	:	972-695-8796

Provider Business Practice Location Address
First Line	:	400 W IH 635 FWY STE 360
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-3764
Country	:	US
Telephone Number	:	972-402-8404
Fax Number	:	972-695-8796

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	04/06/2023

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