Healthcare Provider Details

I. General information

NPI: 1255375945
Provider Name (Legal Business Name): CLALLAM ANESTHESIOLOGIST ASSOCIATED PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OLYMPIC MEDICAL CENTER 939 CAROLINE STREET
PORT ANGELES WA
98362
US

IV. Provider business mailing address

PO BOX 97115
LAKEWOOD WA
98497-0115
US

V. Phone/Fax

Practice location:
  • Phone: 360-417-7450
  • Fax:
Mailing address:
  • Phone: 253-588-7911
  • Fax: 253-974-6774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00033499
License Number StateWA

VIII. Authorized Official

Name: MR. MATTHEW BARTON
Title or Position: SOLE PROPRIETER
Credential: MD
Phone: 360-683-4877