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General NPI Number Information
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NPI Number | 1548384811
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Entity Type | Organization
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Legal Business Name | LYNNE P CLARK MD PS
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 6002 N WESTGATE BLVD SUITE 150
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City | TACOMA
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State | WA
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Zip | 98406-2571
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Country | US
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Telephone | 253-752-8882
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Fax | 253-752-8907
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Provider Business Mailing Address
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Address Line | 6002 N WESTGATE BLVD SUITE 150
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City | TACOMA
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State | WA
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Zip | 98406-2571
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Country | US
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Telephone | 253-752-8882
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Fax | 253-752-8907
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYNNE PATRICIA CLARK
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Credential | MD
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Telephone | 253-752-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD00035921
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License Number State | WA
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