Provider Demographics
NPI:1013999846
Name:CLOUGH, JAMES G (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:CLOUGH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2634
Mailing Address - Country:US
Mailing Address - Phone:406-676-4441
Mailing Address - Fax:406-676-0835
Practice Address - Street 1:104 RUFUS LN
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-8903
Practice Address - Country:US
Practice Address - Phone:406-883-2555
Practice Address - Fax:406-883-2559
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT75213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT390065Medicaid
MT390065Medicaid
T89395Medicare UPIN
MT079440186OtherTRICARE
MT480018508OtherRAILROAD MEDICARE
MT000009123Medicare ID - Type Unspecified