Clark, Jill Elisabeth

Clark, Jill Elisabeth is an individual health care provider with primary practice located at 1135 116Th Ave Ne Ste 550 , Bellevue WA 98004-4623. She recently has only one registered license in Allopathic & Osteopathic Physicians / Colon & Rectal Surgery, which is considered as her primary health care specialty. Clark, Jill Elisabeth can be contacted via phone (425) 646-7400.

Contact Information

Primary practice address
1135 116Th Ave Ne Ste 550 Bellevue WA 98004-4623
Phone: (425) 646-7400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 61161110 Washington

Profile Details

NPI number 1295922052
LBN Legal business name Clark, Jill Elisabeth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2007
Last updated Aug 10th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295922052 NPPES
Utah MEDICAID 1295922052

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