Provider Demographics
NPI:1851439681
Name:GREGORY P CLIFFORD MD PC
Entity Type:Organization
Organization Name:GREGORY P CLIFFORD MD PC
Other - Org Name:LANDER VALLEY EMERGENCY PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-438-2043
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-1276
Mailing Address - Country:US
Mailing Address - Phone:801-423-3306
Mailing Address - Fax:801-423-3309
Practice Address - Street 1:1320 BISHOP RANDALL DR
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3939
Practice Address - Country:US
Practice Address - Phone:801-423-3306
Practice Address - Fax:801-423-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119261200Medicaid