Clyde Harry Koontz, MD

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

14794 Issued in WA

Practice address

316 Martin Luther King Jr Way
Suite 401
Tacoma, WA 98405-4252

Phone

(253) 572-5140

Fax

(253) 272-0419

NPI assigned

Aug 30, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221177600000",
    "number": "1184617607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 MARTIN LUTHER KING JR WAY STE 401",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054266",
            "telephone_number": "253-572-5140",
            "fax_number": "253-272-0419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 MARTIN LUTHER KING JR WAY",
            "address_2": "SUITE 401",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054252",
            "telephone_number": "253-572-5140",
            "fax_number": "253-272-0419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONTZ",
        "first_name": "CLYDE",
        "middle_name": "HARRY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-30",
        "last_updated": "2008-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "14794",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WA",
            "license": "14794",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WA",
            "license": "14794",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "756291101",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13531-01",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Konzelman
• Alex Yushaun Koo, MD
• Shane Yin Koo, DMD
• Kelsi Rae Koon, BEHAVIOR TECHNICIAN
• Charles I Koonce, LMHC
• Alexandra H Koopman, LW61313713
• Sarah Ann Kopaciewicz
• Avery Kopacz, MD
• Robert Kopec, DNP, ARNP
• Zachary Aaron Kopelman, DO

• Critical Care Medicine (Internal Medicine) Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Critical Care Medicine (Internal Medicine) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2008; 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.