Provider Demographics
NPI:1013374388
Name:CLEMENT HOLDINGS
Entity Type:Organization
Organization Name:CLEMENT HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:520-836-2962
Mailing Address - Street 1:1515 E FLORENCE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5334
Mailing Address - Country:US
Mailing Address - Phone:520-836-2962
Mailing Address - Fax:520-836-8343
Practice Address - Street 1:1515 E FLORENCE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5334
Practice Address - Country:US
Practice Address - Phone:520-836-2962
Practice Address - Fax:520-836-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ593213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty