Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | M5398 | ID |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | M5398 | ID |
NPI | 1568500700 |
---|---|
Provider Name | Dr. Kevin A Clifford |
First Address | Boise, ID 83702-5424 |
Second Address | Boise, ID 83702-5424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 26/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D00635 | (02) | ID |