Provider Demographics
NPI:1609271915
Name:BLAIS, CLIFFORD (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:BLAIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CLIFFORD
Other - Middle Name:
Other - Last Name:BLAIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, CM
Mailing Address - Street 1:350 PARKWWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DORVAL
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H9S 3A5
Mailing Address - Country:CA
Mailing Address - Phone:514-943-2579
Mailing Address - Fax:514-631-2405
Practice Address - Street 1:935 MARKET ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4217
Practice Address - Country:US
Practice Address - Phone:530-751-3749
Practice Address - Fax:530-671-4269
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine