MEDICARE: DR. ROBERT LEON CLARK 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	207RP1001X	Pulmonary Disease Physician	MD 00030055	WA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MD 00030055	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	810000222	OTHER	WA	RR MEDICARE
4	P01365435	OTHER	WA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	38110	OTHER		L&I

General Provider Information

NPI Number	:	1508850181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LEON CLARK MD

Provider Business Mailing Address
First Line	:	17058 SE 58TH ST
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-5595
Country	:	US
Telephone Number	:	206-790-2397
Fax Number	:	425-641-4827

Provider Business Practice Location Address
First Line	:	17058 SE 58TH ST
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-5595
Country	:	US
Telephone Number	:	206-790-2397
Fax Number	:	425-641-4827

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	09/28/2016

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Directions to “ DR. ROBERT LEON CLARK MD” Practice Location

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