Healthcare Provider Details

I. General information

NPI: 1306959002
Provider Name (Legal Business Name): DAVID D CLARKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 S.E. SUNNYSIDE RD.
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

9900 S.E. SUNNYSIDE RD.
CLACKAMAS OR
97015
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-8240
  • Fax:
Mailing address:
  • Phone: 503-698-4287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD14023
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD00034690
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: