MEDICARE: CLIFTON ETIENNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	45991	CO

General Provider Information

NPI Number	:	1245425289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFTON ETIENNE MD

Provider Business Mailing Address
First Line	:	12201 PECOS ST
Second Line	:	SUITE 500
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-3888
Country	:	US
Telephone Number	:	303-457-4497
Fax Number	:	303-540-4692

Provider Business Practice Location Address
First Line	:	12201 PECOS ST
Second Line	:	UNIT #500
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-3888
Country	:	US
Telephone Number	:	303-457-4497
Fax Number	:	303-254-4369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	02/23/2012

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