Provider Demographics
NPI:1154379840
Name:CLEMMER, KEVIN R (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:CLEMMER
Suffix:
Gender:
Credentials:DO
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Mailing Address - Street 1:1805 KIPLING ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-2873
Mailing Address - Country:US
Mailing Address - Phone:303-237-2968
Mailing Address - Fax:303-237-5242
Practice Address - Street 1:1805 KIPLING ST
Practice Address - Street 2:SUITE 109
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-2873
Practice Address - Country:US
Practice Address - Phone:303-237-2968
Practice Address - Fax:303-237-5242
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2025-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO34583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01345834Medicaid
CO38612OtherBLUE CROSS BLUE SHIELD
CO38267004801OtherCOLORADO PACIFICARE
COG14848Medicare UPIN
CO38267004801OtherCOLORADO PACIFICARE