Provider Demographics
NPI:1902870736
Name:MAULT, CLIFFORD H (DO)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:H
Last Name:MAULT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1836
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779
Mailing Address - Country:US
Mailing Address - Phone:828-586-0807
Mailing Address - Fax:828-586-8490
Practice Address - Street 1:12 GRINDSTAFF COVE RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779
Practice Address - Country:US
Practice Address - Phone:828-586-0807
Practice Address - Fax:828-586-8490
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300173207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138XCOtherBCBS
NC5900095Medicaid
NC5900095Medicaid
NCH52025Medicare UPIN