Provider Demographics
NPI:1790785236
Name:PUGET SOUND REHABILITATION MEDICINE
Entity Type:Organization
Organization Name:PUGET SOUND REHABILITATION MEDICINE
Other - Org Name:DAVID R CLAWSON, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:CLAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-320-2600
Mailing Address - Street 1:1600 E JEFFERSON ST STE A4
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5656
Mailing Address - Country:US
Mailing Address - Phone:206-320-2600
Mailing Address - Fax:206-320-4054
Practice Address - Street 1:1600 E JEFFERSON ST STE A4
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5656
Practice Address - Country:US
Practice Address - Phone:206-320-2600
Practice Address - Fax:206-320-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0024397208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1055623Medicaid
WA1055623Medicaid
WAGAB02250Medicare PIN