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General NPI Number Information
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NPI Number | 1790721736
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Entity Type | Individual
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Provider Name | JEFFREY CLARK ERNST MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 23511 56TH AVE W STE 105
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-5285
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Country | US
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Telephone | 206-546-2421
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Fax | 206-542-9028
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Provider Business Mailing Address
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Address Line | 23511 56TH AVE W STE 105
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-5285
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Country | US
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Telephone | 206-546-2421
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Fax | 206-542-9028
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 38513
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License Number State | WA
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