Provider Demographics
NPI:1912961152
Name:OLNEY, CLAYTON JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:JOSEPH
Last Name:OLNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 JACKSON
Mailing Address - Street 2:MAMC NICU
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-0895
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON
Practice Address - Street 2:MAMC NICU
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-0895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6639208000000X
WAOP606522252080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044060404Medicaid
TX8795B7Medicare PIN
TX044060404Medicaid
TXG37796Medicare UPIN