MEDICARE: CLINTON ANDERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	41558	MN
2	207Q00000X	Family Medicine Physician	MD60037715	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	062M8AN	OTHER	MN	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134106867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINTON ANDERSON MD

Provider Business Mailing Address
First Line	:	PO BOX 3360
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3360
Country	:	US
Telephone Number	:	866-366-2983
Fax Number	:

Provider Business Practice Location Address
First Line	:	12800 BOTHELL EVERETT HWY
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6642
Country	:	US
Telephone Number	:	425-316-5150
Fax Number	:	425-225-1006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	02/05/2015

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Directions to “ CLINTON ANDERSON MD” Practice Location

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