Clark M Waffle, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

MD00021479 Issued in WA

Practice address

407 14TH Ave SE
Puyallup, WA 98372-3770

Phone

(253) 848-6661

Fax

(253) 770-5990

NPI assigned

Jun 18, 2006

Last updated

Mar 7, 2008By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Good Samaritan Hospital

  • Pulmonary Disease Physician
  • Puyallup, WA
  • NPI 1336160969

  Emergency Medicine

  NPD (past)
• Mt. Rainier Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Puyallup, WA
  • NPI 1538104476
  NPD (past)

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204848000000",
    "number": "1407891922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6814 90TH ST E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983716434",
            "telephone_number": "253-841-0174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 14TH AVE SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723770",
            "telephone_number": "253-848-6661",
            "fax_number": "253-770-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAFFLE",
        "first_name": "CLARK",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2008-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00021479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002369",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Lynn Vrieze, OT
• Annalise Vue
• Christine Konhzoua Vue, OTR
• Ann Waddell
• Zerka Wadood, M.D.
• Allison Jones Waggoner
• Robert Eugene Wagner, D.C.
• Steven William Wagner
• Tiffany Wagner, LMP
• Valerie Ann Wagoner, SLP

• Emergency Medicine Physician in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Emergency Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.