Provider Demographics
NPI:1932163508
Name:CLIFFORD, JARED T (DPM)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:T
Last Name:CLIFFORD
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 1:723 MEMORIAL ST
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1524
Mailing Address - Country:US
Mailing Address - Phone:509-786-5599
Mailing Address - Fax:509-788-0488
Practice Address - Street 1:820 MEMORIAL ST STE 3
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-2504
Practice Address - Country:US
Practice Address - Phone:509-786-5599
Practice Address - Fax:509-788-0488
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00361213ES0103X
WAPO772213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8478547Medicaid
OR277935Medicaid
WA1306897681OtherPROSSER PUBLIC HOSPITAL DISTRICT OF BENTON CO.
WA1306897681OtherPROSSER PUBLIC HOSPITAL DISTRICT OF BENTON CO.
OR131255Medicare ID - Type Unspecified
WA8864815Medicare PIN