Provider Demographics
NPI:1104142686
Name:CLIFFORD, CRAIG (DPM)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 TALBOT RD S STE 102
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6238
Mailing Address - Country:US
Mailing Address - Phone:425-277-3668
Mailing Address - Fax:425-277-0732
Practice Address - Street 1:34612 6TH AVE S
Practice Address - Street 2:SUITE 300
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8723
Practice Address - Country:US
Practice Address - Phone:253-838-8552
Practice Address - Fax:253-874-6089
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60290950213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8912601OtherMEDICARE
WA455507OtherLNI
WA2020061Medicaid
WAG8912601OtherMEDICARE