Individual
JON C CLYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
217 W CATALDO AVE, SPOKANE, WA 99201-2217
(509) 747-6194
(509) 838-0824
Mailing address
PO BOX 2242, SPOKANE, WA 99210-2242
(509) 747-6194
(509) 838-0824
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD00027478
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021532
—
WA
01
—
305785
LABOR& INDUSTRIES
WA
01
—
P01152325
RAILROAD MEDICARE
WA
Enumeration date
02/03/2006
Last updated
09/08/2016
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