Individual
DR. CLARK EDMUND SISK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3600 N INTERSTATE AVE, PORTLAND, OR 97227-1106
(503) 331-3033
(503) 280-2930
Mailing address
3600 N INTERSTATE AVE, KAISER, DERMATOLOGY, CENTRAL INTERSTATE MEDICAL OFFICE, PORTLAND, OR 97227-1106
(503) 331-3060
(503) 290-2930
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OR MD12188
OR
207N00000X
Dermatology Physician
WA MD00035021
WA
Other
Enumeration date
08/20/2006
Last updated
07/09/2007
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