Provider Demographics
NPI:1548472996
Name:CRAFTON, CLIFFORD GENE (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:GENE
Last Name:CRAFTON
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MISTLETOE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4530
Mailing Address - Country:US
Mailing Address - Phone:985-892-4546
Mailing Address - Fax:
Practice Address - Street 1:43 MISTLETOE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4530
Practice Address - Country:US
Practice Address - Phone:985-892-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA123772084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1152064Medicaid
LA1152064Medicaid