Healthcare Provider Details

I. General information

NPI: 1356509475
Provider Name (Legal Business Name): CAMILLE MELINDA CLINTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 120TH AVE NE SUITE H-210
KIRKLAND WA
98034-3027
US

IV. Provider business mailing address

805 MADISON STREET SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-4000
  • Fax: 425-821-3550
Mailing address:
  • Phone: 206-264-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60010627
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number244646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: