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General NPI Number Information
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NPI Number | 1740251792
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Entity Type | Individual
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Provider Name | GARY JAMES CLANCEY MD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1401 S LAVENTURE RD
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City | MOUNT VERNON
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State | WA
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Zip | 98274-6033
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Country | US
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Telephone | 360-424-2400
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Fax | 360-424-2428
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Provider Business Mailing Address
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Address Line | 720 OLIVE WAY SUITE 1505
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City | SEATTLE
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State | WA
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Zip | 98101-1878
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Country | US
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Telephone | 206-838-2590
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Fax | 206-264-8689
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD00013886
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License Number State | WA
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