Healthcare Provider Details

I. General information

NPI: 1912961152
Provider Name (Legal Business Name): CLAYTON JOSEPH OLNEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON MAMC NICU
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9040 JACKSON MAMC NICU
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0895
  • Fax:
Mailing address:
  • Phone: 253-968-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ6639
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberOP60652225
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: