# CLOVER PODIATRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912525288
- **Authorized official:** TEK MANNING FISH DPM (SURGEON/OWNER)
- **Authorized official phone:** (360) 450-6644

## Contact information

- **Practice address:** 405 NE 6TH AVE, CAMAS, WA 98607-2037
- **Practice address phone:** (360) 450-6644
- **Practice address fax:** (360) 524-7847
- **Mailing address:** 405 NE 6TH AVE, CAMAS, WA 98607-2037
- **Mailing address phone:** (360) 450-6644
- **Mailing address fax:** (360) 524-7847

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2020
- **Last updated:** 01/22/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2169432 | — | WA |