Provider Demographics
NPI:1871571786
Name:FOUSS, CLINTON STUART
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:STUART
Last Name:FOUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CLINTON
Other - Middle Name:
Other - Last Name:FOUSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:P.O. BOX 173891
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-9294
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-365-6820
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42412207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54320275Medicaid
CO537178Medicare PIN
COI08517Medicare UPIN