Provider Demographics
NPI:1316174428
Name:CLIFTON, BLAKE C (MD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:C
Last Name:CLIFTON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2545
Mailing Address - Country:US
Mailing Address - Phone:970-641-6788
Mailing Address - Fax:970-641-0282
Practice Address - Street 1:3676 PARKER BLVD STE 390
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2215
Practice Address - Country:US
Practice Address - Phone:719-595-7780
Practice Address - Fax:719-595-7789
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10034019207X00000X
NMRS2014-0362390200000X
CODR0055411207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program