Provider Demographics
NPI:1902868102
Name:CLAYPOOL, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:CLAYPOOL
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 782
Mailing Address - Street 2:
Mailing Address - City:SUMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98295-0782
Mailing Address - Country:US
Mailing Address - Phone:360-988-9404
Mailing Address - Fax:360-988-9409
Practice Address - Street 1:112 COLUMBIA LANE
Practice Address - Street 2:
Practice Address - City:SUMAS
Practice Address - State:WA
Practice Address - Zip Code:98295
Practice Address - Country:US
Practice Address - Phone:360-988-9404
Practice Address - Fax:360-988-9409
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1100536Medicaid
WAG000300240Medicare PIN
WAA07133Medicare UPIN
WA1100536Medicaid