Koontz, Clyde Harry
Koontz, Clyde Harry is an individual health care provider with primary practice located at 316 Martin Luther King Jr Way Suite 401, Tacoma WA 98405-4252. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Critical Care Medicine is his primary health care specialty. Koontz, Clyde Harry can be contacted via phone (253) 572-5140.Contact Information
Primary practice address
316 Martin Luther King Jr Way Suite 401
Tacoma WA 98405-4252
Phone: (253) 572-5140
Fax: (253) 272-0419
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 14794 | Washington |
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | 14794 | Washington |
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | 14794 | Washington |
Profile Details
| NPI number | 1184617607 |
|---|---|
| LBN Legal business name | Koontz, Clyde Harry |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 30th, 2005 |
| Last updated | Sep 12th, 2008 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184617607 | NPPES |
| Washington | Other | 756291101 | RR MEDICARE |
| Washington | MEDICAID | 13531-01 | RR MEDICARE |
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