Organization
MICHAEL P. CLEMENTS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL P CLEMENTS MD (SOLE PROPRIETOR)
(575) 973-5864
Entity
Organization
Contact information
Practice address
1096 MECHEM DR STE G05, RUIDOSO, NM 88345-7057
(575) 973-5864
(575) 258-2648
Mailing address
1096 MECHEM DR STE G05, RUIDOSO, NM 88345-7057
(575) 973-5864
(575) 258-2648
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
314000000X
Skilled Nursing Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
67601081
—
NM
05
—
Q0066
—
NM
Enumeration date
11/22/2019
Last updated
12/10/2019
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