Individual
CLIFFORD D CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 E PROSPECT RD, FORT COLLINS, CO 80525-9718
(970) 493-0112
Mailing address
2500 E PROSPECT RD, FORT COLLINS, CO 80525-9718
(970) 439-0112
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
DR.0047585
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12688200
—
WY
05
—
66729378
—
CO
01
—
P00755984
RR MEDICARE
CO
Enumeration date
07/18/2006
Last updated
12/16/2019
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