Provider Demographics
NPI:1528057205
Name:CLARKE, GEORGE ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ANDREW
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G. ANDREW
Other - Middle Name:
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:SUITE 4010
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3975
Mailing Address - Country:US
Mailing Address - Phone:503-561-2448
Mailing Address - Fax:503-561-4759
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:SUITE 4010
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3975
Practice Address - Country:US
Practice Address - Phone:503-561-2448
Practice Address - Fax:503-561-4759
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27012208600000X
LA022837208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery