Provider Demographics
NPI:1265079420
Name:KINNEAR, CLIFFORD THOMAS JR
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:THOMAS
Last Name:KINNEAR
Suffix:JR
Gender:M
Credentials:
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 30003
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003-8003
Mailing Address - Country:US
Mailing Address - Phone:575-646-5426
Mailing Address - Fax:
Practice Address - Street 1:1003 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4246
Practice Address - Country:US
Practice Address - Phone:575-921-1873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator