Provider Demographics
NPI:1538138243
Name:BEHREND, CLINT E (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:E
Last Name:BEHREND
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 1:2770 CORTEZ AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7590
Mailing Address - Country:US
Mailing Address - Phone:208-522-4000
Mailing Address - Fax:208-528-4254
Practice Address - Street 1:2770 CORTEZ AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7590
Practice Address - Country:US
Practice Address - Phone:208-522-4000
Practice Address - Fax:208-528-4254
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7328207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804261800Medicaid
IDF96012Medicare UPIN
ID804261800Medicaid