Healthcare Provider Details

I. General information

NPI: 1316174428
Provider Name (Legal Business Name): BLAKE C CLIFTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3676 PARKER BLVD STE 390
PUEBLO CO
81008-2215
US

IV. Provider business mailing address

112 W SPENCER AVE
GUNNISON CO
81230-2545
US

V. Phone/Fax

Practice location:
  • Phone: 719-595-7780
  • Fax: 719-595-7789
Mailing address:
  • Phone: 970-641-6788
  • Fax: 970-641-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2014-0362
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberBP10034019
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberDR0055411
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: