Individual
DR. CLINTON R. CHILDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1130 E LANSING, BROKEN ARROW, OK 74012
(918) 258-9990
(918) 994-4277
Mailing address
PO BOX 140728, BROKEN ARROW, OK 74014
(918) 258-9990
(918) 994-4277
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19517
OK
207Q00000X
Family Medicine Physician
K3130
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
047146801
—
TX
05
—
047146802
—
TX
01
—
080175359
RR MEDICARE
TX
01
—
8A9711
BCBS
TX
Enumeration date
05/24/2006
Last updated
09/26/2018
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