Provider Demographics
NPI:1649606377
Name:BLISS, CLIFFORD M (DPM)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:M
Last Name:BLISS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2421 IRA E WOODS AVE
Mailing Address - Street 2:100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3906
Mailing Address - Country:US
Mailing Address - Phone:817-416-6155
Mailing Address - Fax:817-329-9434
Practice Address - Street 1:2421 IRA E WOODS AVE
Practice Address - Street 2:100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3906
Practice Address - Country:US
Practice Address - Phone:817-416-6155
Practice Address - Fax:817-329-9434
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2221213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX501538YULFMedicare PIN