Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Southlake Clinic Inc , P.s.

Organization Dermatology Physician · NPI 1104962331

Southlake Clinic Inc , P.s. is a Dermatology Physician in Renton, Washington. Registered with an NPI since 2007.

In the registry since
2007
Specialties on file
15
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

4011 Talbot Rd S Ste 500
Renton, WA 98055-5773
Phone: (425) 251-5110
Fax: (425) 793-4707
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Dermatology Physician Taxonomy 207N00000X
Cardiovascular Disease Physician Taxonomy 207RC0000X
Critical Care Medicine (Internal Medicine) Physician Taxonomy 207RC0200X
Endocrinology, Diabetes & Metabolism Physician Taxonomy 207RE0101X
Gastroenterology Physician Taxonomy 207RG0100X
Hematology & Oncology Physician Taxonomy 207RH0003X
Interventional Cardiology Physician Taxonomy 207RI0011X
Infectious Disease Physician Taxonomy 207RI0200X
Pulmonary Disease Physician Taxonomy 207RP1001X
Sleep Medicine (Internal Medicine) Physician Taxonomy 207RS0012X
Nuclear Cardiology Physician Taxonomy 207UN0901X
Hospitalist Physician Taxonomy 208M00000X
Physician Assistant Taxonomy 363A00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1104962331
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official James Hudson — Coo · (425) 793-4725
Other names Valley Internal Medicine Inc Ps
NPI enumeratedJanuary 29, 2007
Last updated in NPPESJuly 13, 2017
Mailing addressPo Box 59028, Renton, WA 98058-2028

Other providers in Renton