Provider Demographics
NPI:1568500700
Name:CLIFFORD, KEVIN A (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1015 W HAYS ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5424
Mailing Address - Country:US
Mailing Address - Phone:208-473-1348
Mailing Address - Fax:844-685-6758
Practice Address - Street 1:1015 W HAYS ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5424
Practice Address - Country:US
Practice Address - Phone:208-473-1348
Practice Address - Fax:844-685-6758
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2016-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM5398207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDD00635Medicare UPIN