Provider Demographics
NPI:1225471170
Name:CLEMENT, TIMOTHY WEISS (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WEISS
Last Name:CLEMENT
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 1:100 DANA AVENUE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801
Mailing Address - Country:US
Mailing Address - Phone:509-661-3708
Mailing Address - Fax:509-665-6211
Practice Address - Street 1:820 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2028
Practice Address - Country:US
Practice Address - Phone:206-583-6079
Practice Address - Fax:206-341-1881
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60789507207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1225471170Medicaid
WAG8969913OtherWVH PTAN
WAG8969914OtherWVH PTAN