Healthcare Provider Details

I. General information

NPI: 1265735070
Provider Name (Legal Business Name): AARON B CLANCY PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 YAKIMA AVE STE 104
TACOMA WA
98405-5303
US

IV. Provider business mailing address

1802 YAKIMA AVE STE 104
TACOMA WA
98405-5303
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6272
  • Fax: 253-426-4060
Mailing address:
  • Phone: 253-426-6272
  • Fax: 253-426-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA60193398
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: