Provider Demographics
NPI:1538151048
Name:CURTIS, CLINTON E (MD)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:E
Last Name:CURTIS
Suffix:
Gender:M
Credentials:MD
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 337
Mailing Address - Street 2:
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-0337
Mailing Address - Country:US
Mailing Address - Phone:304-574-3960
Mailing Address - Fax:304-574-2179
Practice Address - Street 1:221 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-1413
Practice Address - Country:US
Practice Address - Phone:304-574-3960
Practice Address - Fax:304-574-2179
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1801082000Medicaid
WV1801082000Medicaid
WV2029021Medicare PIN
WV2029025Medicare PIN
H18667Medicare UPIN
WV2029024Medicare PIN
WV2029022Medicare PIN