MEDICARE: DAVID P. CLEMENS 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	207Q00000X	Family Medicine Physician	MD11783	OK
2	207Q00000X	Family Medicine Physician	MD 60137713	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080085487	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	731297740002	OTHER	OK	BLUE CROSS BLUE SHIELD
3	5300256	OTHER	OK	AETNA EDI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558353227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID P. CLEMENS M.D.

Provider Business Mailing Address
First Line	:	243 111TH AVE SE
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-6308
Country	:	US
Telephone Number	:	425-502-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	12360 LAKE CITY WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5447
Country	:	US
Telephone Number	:	206-384-4382
Fax Number	:	206-440-3137

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	12/01/2010

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Directions to “ DAVID P. CLEMENS M.D.” Practice Location

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