Provider Demographics
NPI:1033228655
Name:BLISS, CLINTON LEE (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:LEE
Last Name:BLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7308
Mailing Address - Country:US
Mailing Address - Phone:206-620-0611
Mailing Address - Fax:206-620-0622
Practice Address - Street 1:4200 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7308
Practice Address - Country:US
Practice Address - Phone:206-620-0611
Practice Address - Fax:206-620-0622
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00028830207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine