Individual
CLIFFORD KEVIN WANEBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
810 MAZATLAN DR, GRAND JUNCTION, CO 81506-1773
(970) 243-8946
Mailing address
810 MAZATLAN DR, GRAND JUNCTION, CO 81506-1773
(970) 243-8946
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
14570
CO
Other
Enumeration date
08/22/2006
Last updated
07/08/2007
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