Healthcare Provider Details

I. General information

NPI: 1104142686
Provider Name (Legal Business Name): CRAIG CLIFFORD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 14TH ST
OREGON CITY OR
97045-1646
US

IV. Provider business mailing address

216 14TH ST
OREGON CITY OR
97045-1646
US

V. Phone/Fax

Practice location:
  • Phone: 971-359-5299
  • Fax: 815-234-1001
Mailing address:
  • Phone: 971-359-5299
  • Fax: 815-234-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP223184
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: