Provider Demographics
NPI:1134170400
Name:CLOUGH, JEFFERY (MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:CLOUGH
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 1:1600 PR CTR PKWY
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4006
Mailing Address - Country:US
Mailing Address - Phone:303-422-9438
Mailing Address - Fax:
Practice Address - Street 1:15502 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4106
Practice Address - Country:US
Practice Address - Phone:303-422-9438
Practice Address - Fax:303-422-9474
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2943174400000X
CODR.0032419207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCI9459OtherGROUPS RAILROAD MCR#
AK020257499OtherGROUPS ENERGY EMP#
AKMD1730Medicaid
CO01324193Medicaid
AK193975000OtherGROUPS FED DOL#
AK050082635OtherCLOUGHS RAILROAD MCR#
AKMDG417Medicaid
AK193975000OtherGROUPS FED DOL#
AK150657Medicare ID - Type UnspecifiedGROUPS MDR#
AKMD1730Medicaid
CO01324193Medicaid