Healthcare Provider Details

I. General information

NPI: 1134170400
Provider Name (Legal Business Name): JEFFERY CLOUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15502 HILLTOP DR
BRIGHTON CO
80601-4106
US

IV. Provider business mailing address

1600 PR CTR PKWY
BRIGHTON CO
80601-4006
US

V. Phone/Fax

Practice location:
  • Phone: 303-422-9438
  • Fax: 303-422-9474
Mailing address:
  • Phone: 303-422-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2943
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0032419
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: