Individual
RONALD LARSON CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14279 GLEN OAK RD, OREGON CITY, OR 97045-8008
(503) 657-7629
(503) 557-8651
Mailing address
5178 NELCO CT, WEST LINN, OR 97068-2906
(503) 557-9384
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD16593
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009496
—
OR
01
—
67972000
BCBS
OR
Enumeration date
06/02/2006
Last updated
12/11/2012
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