Provider Demographics
NPI:1295848489
Name:NEMETH, CLIFFORD J (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:J
Last Name:NEMETH
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 1:1647 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-669-9100
Mailing Address - Fax:
Practice Address - Street 1:2315 E HARMONY RD
Practice Address - Street 2:STE 140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8620
Practice Address - Country:US
Practice Address - Phone:970-484-6700
Practice Address - Fax:970-484-5723
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23635208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01236355Medicaid
CO01236355Medicaid
P00364222Medicare PIN
COD24304Medicare UPIN