Individual
KEVIN LEONARD MCCLINTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1207 PUEBLO BOULEVARD WAY, PUEBLO, CO 81005-2175
(195) 420-0327
(719) 542-1413
Mailing address
801 WEST COLORADO AVE, TRINIDAD, CO 81082-1319
(719) 846-3133
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35456
CO
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
DR.0035456
CO
208M00000X
Hospitalist Physician
DR.0035456
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01354562
—
CO
Enumeration date
05/02/2006
Last updated
02/14/2020
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