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Individual

MR. KYLE L CLIFFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2006 BIRDIE THOMPSON DRIVE, POCATELLO, ID 83201
(208) 232-1132
(208) 232-1134
Mailing address
2006 BIRDIE THOMPSON DRIVE, POCATELLO, ID 83201
(208) 232-1132
(208) 232-1134

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M9775
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
807255600
ID
Enumeration date
09/19/2005
Last updated
08/05/2010
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