Provider Demographics
NPI:1225187826
Name:CLARK, JAMES ERIC (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ERIC
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1632 116TH AVE NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3035
Mailing Address - Country:US
Mailing Address - Phone:425-462-9800
Mailing Address - Fax:425-454-9143
Practice Address - Street 1:1632 116TH AVE NE
Practice Address - Street 2:SUITE C
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3035
Practice Address - Country:US
Practice Address - Phone:425-462-9800
Practice Address - Fax:425-454-9143
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA0050416207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1089044Medicaid
F38419Medicare UPIN
WA1089044Medicaid