MEDICARE: DR. CAROL L CLIFFORD AUD

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	231H00000X	Audiologist	1124	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	NM00184	OTHER	NM	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM00K42W	OTHER	NM	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598768657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL L CLIFFORD AUD

Provider Business Mailing Address
First Line	:	10700 CORRALES ROAD
Second Line	:	SUITE I
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114
Country	:	US
Telephone Number	:	505-890-0003
Fax Number	:	505-890-3330

Provider Business Practice Location Address
First Line	:	10700 CORRALES ROAD
Second Line	:	SUITE I
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114
Country	:	US
Telephone Number	:	505-890-0003
Fax Number	:	505-890-3330

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/13/2016

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Directions to “ DR. CAROL L CLIFFORD AUD” Practice Location

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