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Individual

DR. SCOTT E CLEMENSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
580 MOHAWK DR, BOULDER, CO 80303-3712
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
228550
NY
207Q00000X
Family Medicine Physician
Primary
47105
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
19471
KAISER COMMERCIAL NUMBER
CO
05
45278857
CO
01
7132714
AETNA
NY
01
MDJ022
PREFERRED CARE
NY
01
P010228650
BLUE CHOICE
NY
Enumeration date
08/22/2006
Last updated
04/20/2021
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