MEDICARE: DR. HERBERT R. CLARK M.D.

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	207X00000X	Orthopaedic Surgery Physician	MD00020828	WA

General Provider Information

NPI Number	:	1427095413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERBERT R. CLARK M.D.

Provider Business Mailing Address
First Line	:	805 MADISON ST
Second Line	:	SUITE 901
City	:	SEATTLE
State	:	WA
Zip	:	98104-1172
Country	:	US
Telephone Number	:	206-264-8400
Fax Number	:	206-264-8689

Provider Business Practice Location Address
First Line	:	9730 3RD AVE NE
Second Line	:	SUITE 201
City	:	SEATTLE
State	:	WA
Zip	:	98115-2023
Country	:	US
Telephone Number	:	206-526-8444
Fax Number	:	206-526-0521

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	10/07/2011

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