Provider Demographics
NPI:1265454847
Name:CLARKSON, THOMAS ALAN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:CLARKSON
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-366-2983
Mailing Address - Fax:
Practice Address - Street 1:12800 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6642
Practice Address - Country:US
Practice Address - Phone:425-316-5150
Practice Address - Fax:425-225-1006
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0201342OtherL & I WORKERS COMP
WA8917614OtherL & I CRIME VICTIMS
WA8228595Medicaid
WA6520CLOtherREGENCE BLUESHIELD RIDER
WA6520CLOtherREGENCE BLUESHIELD RIDER
WAE88943Medicare UPIN
WAG8877966Medicare PIN
WA6520CLOtherREGENCE BLUESHIELD RIDER