Provider Demographics
NPI:1932367190
Name:TSE, CLIFFORD (MD, MPH)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:TSE
Suffix:
Gender:M
Credentials:MD, MPH
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 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:775-751-6566
Mailing Address - Fax:775-751-6590
Practice Address - Street 1:2210 E CALVADA BLVD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5804
Practice Address - Country:US
Practice Address - Phone:775-751-6566
Practice Address - Fax:775-751-6590
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115222207Q00000X
NV14293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1932367190Medicaid
NVGG665ZMedicare PIN
NVGG665YMedicare PIN