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General NPI Number Information
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NPI Number | 1669892568
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Entity Type | Individual
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Provider Name | CLIFTON CASSIDY II D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 17700 SE 272ND ST
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City | COVINGTON
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State | WA
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Zip | 98042-4951
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Country | US
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Telephone | 253-545-2203
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1247 MS1322-2-EFM
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City | PUYALLUP
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State | WA
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Zip | 98371-0192
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Country | US
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Telephone |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | OP60627578
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP60627578
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License Number State | WA
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