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General NPI Number Information
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NPI Number | 1811168339
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Entity Type | Individual
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Provider Name | JANICE PATRECE CLARK DPM
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Gender | Female
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1660 S COLUMBIAN WAY
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City | SEATTLE
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State | WA
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Zip | 98108-1532
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Country | US
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Telephone | 206-716-5651
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 467
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City | ZUNI
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State | NM
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Zip | 87327-0467
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Country | US
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Telephone | 210-842-6826
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Fax | 505-782-7330
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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 | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | POD001114
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | CL011
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0689
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | R57676
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD001114
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License Number State | GA
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