Provider Demographics
NPI:1891791232
Name:PARRISH, CLARK O (MD)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:O
Last Name:PARRISH
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 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-738-2200
Mailing Address - Fax:360-715-2486
Practice Address - Street 1:4545 CORDATA PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7123
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-715-2486
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD188136207R00000X
WAMD00024849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4587184OtherAETNA
WA1032549Medicaid
WA12304OtherREGENCE
WA0230044OtherL&I AND CRIME VICTIMS
WA1891791232Medicaid
WAG8872905Medicare PIN
WA12304OtherREGENCE
WAG88729045Medicare PIN