Healthcare Provider Details

I. General information

NPI: 1871941054
Provider Name (Legal Business Name): CLIFFORD SCOTT GOLDTHORPE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CLIFFORD SCOTT GOLDTHORPE DO

II. Dates (important events)

Enumeration Date: 05/30/2016
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 30TH ST BLDG D-101
FARMINGTON NM
87401-8991
US

IV. Provider business mailing address

PO BOX 844088
DALLAS TX
75284-4088
US

V. Phone/Fax

Practice location:
  • Phone: 505-208-6280
  • Fax: 505-564-3202
Mailing address:
  • Phone: 505-609-2258
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO2025-0028
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: