Healthcare Provider Details

I. General information

NPI: 1780375246
Provider Name (Legal Business Name): JORDAN D CLEMENT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E HILL AVE
MOSES LAKE WA
98837-2238
US

IV. Provider business mailing address

840 E HILL AVE
MOSES LAKE WA
98837-2238
US

V. Phone/Fax

Practice location:
  • Phone: 509-764-7400
  • Fax: 509-764-6437
Mailing address:
  • Phone: 509-764-7400
  • Fax: 509-764-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP.70058514
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: