Individual
DR. CLIFFORD GLENN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 SAINT ANTHONYS WAY, ALTON, IL 62002-4569
(618) 462-2222
Mailing address
2 SAINT ANTHONYS WAY, ALTON, IL 62002-4569
(618) 462-2222
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01072884A
IN
207V00000X
Obstetrics & Gynecology Physician
30961-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201311140
—
IN
Enumeration date
04/06/2006
Last updated
04/29/2016
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