Provider Demographics
NPI:1134133788
Name:NAKAYAMA, CLYDE H (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:H
Last Name:NAKAYAMA
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 1:4170 ORCHARD WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1875
Mailing Address - Country:US
Mailing Address - Phone:503-636-1497
Mailing Address - Fax:503-636-1497
Practice Address - Street 1:4170 ORCHARD WAY
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1875
Practice Address - Country:US
Practice Address - Phone:503-636-1497
Practice Address - Fax:503-636-1497
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10953207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1488808Medicaid
OR075069Medicaid
OR050050476OtherRR MEDICARE
WA1488808Medicaid
OR075069Medicaid