Provider Demographics
NPI:1023006533
Name:CLIFFORD, GREGORY PAUL (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:CLIFFORD
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:PO BOX 678898
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8898
Mailing Address - Country:US
Mailing Address - Phone:801-423-3306
Mailing Address - Fax:719-591-2745
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:307-335-6365
Practice Address - Fax:307-332-0312
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5956A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113014500Medicaid
WY113014500Medicaid
WY10164Medicare ID - Type Unspecified