Individual
CLANCY J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 9TH AVE, SEATTLE, WA 98101
(206) 624-1144
Mailing address
2450 GREENBRIER RD, WINSTON SALEM, NC 27104-2108
(336) 480-8064
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2012-01216
NC
208600000X
Surgery Physician
Primary
MD61617432
WA
2086X0206X
Surgical Oncology Physician
2012-01216
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5920754
—
NC
Enumeration date
02/18/2007
Last updated
12/13/2024
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