Provider Demographics
NPI:1023082732
Name:CLEMETT, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:CLEMETT
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 1:19020 33RD AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4746
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031112174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL5689OtherREGENCE
WA109454OtherL&I
WA8149999Medicaid
WA0348932OtherL & I - RADIA-KING COUNTY
WA0348933OtherL & I - SWEDISH RADIA
WA0348935OtherL & I - EVERGREEN RADIA
300068357OtherRAILROAD MEDICARE
WA0348930OtherL & I - RADIA-REST OF WA
WA1000592Medicaid
4484036OtherAETNA
8919559OtherCRIME VICTIMS
WA0348932OtherL & I - RADIA-KING COUNTY
CL5689OtherREGENCE
WA1000592Medicaid
300068357OtherRAILROAD MEDICARE
WAP01623664Medicare PIN
WA0348930OtherL & I - RADIA-REST OF WA
WA8149999Medicaid
WAP01623653Medicare PIN
8919559OtherCRIME VICTIMS