Individual
DR. JANICE PATRECE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1660 S COLUMBIAN WAY, SEATTLE, WA 98108-1532
(206) 716-5651
Mailing address
PO BOX 467, ZUNI, NM 87327-0467
(210) 842-6826
(505) 782-7330
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
POD001114
GA
213ES0103X
Foot & Ankle Surgery Podiatrist
0689
AZ
213ES0103X
Foot & Ankle Surgery Podiatrist
CL011
NM
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD001114
GA
213ES0103X
Foot & Ankle Surgery Podiatrist
R57676
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1289105
AMERIGROUP
GA
01
—
2009-07-20
CIGNA
GA
01
—
2009-08-01
UNITED HEALTHCARE
GA
01
—
2009-10-01
PSHP
GA
01
—
20091544
SELECT HEALTH
GA
05
—
294861171A
—
GA
01
—
519981
WELLCARE
GA
01
—
52246038-001
BCBSGA
GA
05
—
GPD114
—
SC
01
—
PAR
AETNA
GA
01
—
PAR-2009-07-20
GREAT WEST
GA
01
—
PAR-2009-08-28
TRICARE
GA
Enumeration date
03/13/2008
Last updated
07/21/2022
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