Clark, Travis M

Clark, Travis M is an individual health care provider with primary practice located at 820 N Chelan Ave , Wenatchee WA 98801-2028. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Clark, Travis M can be contacted via phone (509) 663-8711.

Contact Information

Primary practice address
820 N Chelan Ave Wenatchee WA 98801-2028
Phone: (509) 663-8711
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X MD00043882 Washington

Profile Details

NPI number 1083647838
LBN Legal business name Clark, Travis M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2006
Last updated Jun 14th, 2022 - about 2 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 1083647838 NPPES
Washington Other 315801 L&I POST 7/21/13
Washington MEDICAID 1083647838 L&I POST 7/21/13
Washington Other P01256570 L&I POST 7/21/13
Washington Other 0187471 L&I POST 7/21/13

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