Provider Demographics
NPI:1255312625
Name:CLEMENS, ORRIE G (MD)
Entity Type:Individual
Prefix:DR
First Name:ORRIE
Middle Name:G
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 STONEY HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1373
Mailing Address - Country:US
Mailing Address - Phone:970-221-0565
Mailing Address - Fax:970-221-0575
Practice Address - Street 1:2001 S SHIELDS ST
Practice Address - Street 2:BLDG L
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1827
Practice Address - Country:US
Practice Address - Phone:970-221-0565
Practice Address - Fax:970-221-0575
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17195208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01171958Medicaid
COCO40667Medicare PIN
D23215Medicare UPIN
CO01171958Medicaid