Provider Demographics
NPI:1467436139
Name:CLEMENTE, ARTHUR L (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:L
Last Name:CLEMENTE
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 1:8507 S 5TH ST STE 113
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-3422
Mailing Address - Country:US
Mailing Address - Phone:360-887-9494
Mailing Address - Fax:
Practice Address - Street 1:8507 S 5TH ST # 113
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-3421
Practice Address - Country:US
Practice Address - Phone:360-887-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 87368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270880900Medicaid
FL81225BMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE