Provider Demographics
NPI:1861427346
Name:CLEMEN, JAMES T (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:CLEMEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11311 BRIDGEPORT WAY SW STE 309
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3078
Mailing Address - Country:US
Mailing Address - Phone:253-985-2733
Mailing Address - Fax:253-985-2868
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 309
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3078
Practice Address - Country:US
Practice Address - Phone:253-985-2733
Practice Address - Fax:253-985-2868
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00028427208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1020756Medicaid