Individual
CLIFFORD M. COSTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 E CLEVELAND ST, MONETT, MO 65708-6149
(417) 236-2600
(417) 236-2619
Mailing address
3800 S NATIONAL AVE, #540, SPRINGFIELD, MO 65807-5209
(417) 236-2600
(417) 236-2619
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36273
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201967833
—
MO
Enumeration date
08/28/2006
Last updated
12/04/2012
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