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General NPI Number Information
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NPI Number | 1225141823
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Entity Type | Individual
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Provider Name | GREGORY LYNN CLARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 11790 SW BARNES RD SUITE 330
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City | PORTLAND
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State | OR
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Zip | 97225-5934
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Country | US
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Telephone | 503-228-4414
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Fax |
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Provider Business Mailing Address
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Address Line | 11790 SW BARNES RD SUITE 330
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City | PORTLAND
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State | OR
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Zip | 97225-5934
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Country | US
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Telephone | 503-228-4414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OR MD18493
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | WA MD00035294
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | MD18493
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License Number State | OR
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