Roy D Clark Jr., MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD00016516 Issued in WA

Practice address

509 Olive Way
#531
Seattle, WA 98101-1725

Phone

(206) 682-5203

Fax

(206) 682-5304

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003965419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 OLIVE WAY",
            "address_2": "#531",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981011725",
            "telephone_number": "206-682-5203",
            "fax_number": "206-682-5304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 OLIVE WAY",
            "address_2": "#531",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981011725",
            "telephone_number": "206-682-5203",
            "fax_number": "206-682-5304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ROY",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00016516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quinton Dinard Clark
• Rachel Marie Clark, MD
• Randie Clark, LMHC
• Richard Douglas Clark, M.D. PH.D.
• Rochelle Lenore Clark, LMP, CLT
• Sarah Clark, M.D.
• Sashya Clark
• Tabetha Clark
• Tara W. Clark, SLP
• Theresa-Ann Clark, MD

• Psychiatry Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.