Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 45494 | CO |
NPI | 1366478034 |
---|---|
Provider Name | Dr. Kirk D Clifford |
First Address | Grand Junction, CO 81505-6401 |
Second Address | Grand Junction, CO 81505-6401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 30/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40982301 | (05) | CO |
I61679 | (02) | CO |