Individual
DR. ROBERT LEON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17058 SE 58TH ST, BELLEVUE, WA 98006-5595
(206) 790-2397
(425) 641-4827
Mailing address
17058 SE 58TH ST, BELLEVUE, WA 98006-5595
(206) 790-2397
(425) 641-4827
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD 00030055
WA
207RP1001X
Pulmonary Disease Physician
Primary
MD 00030055
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508850181
—
WA
01
—
38110
L&I
—
01
—
810000222
RR MEDICARE
WA
01
—
P01365435
RR MEDICARE
WA
Enumeration date
09/09/2005
Last updated
09/28/2016
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