Healthcare Provider Details

I. General information

NPI: 1134182801
Provider Name (Legal Business Name): THOMAS A CLINGAN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PEDIATRICS MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-0001
US

IV. Provider business mailing address

28 ORCHARD RD N
TACOMA WA
98406-7618
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2310
  • Fax: 253-968-5294
Mailing address:
  • Phone: 253-761-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD00021298
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: