MEDICARE: ERIC PETER CLARKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	21142	TN
2	207X00000X	Orthopaedic Surgery Physician	032102	GA
3	174400000X	Specialist	29432	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023002466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC PETER CLARKE MD

Provider Business Mailing Address
First Line	:	PO BOX 23446
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37422
Country	:	US
Telephone Number	:	423-624-8588
Fax Number	:	423-622-3069

Provider Business Practice Location Address
First Line	:	2707 CITICO AVENUE
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37406-3402
Country	:	US
Telephone Number	:	423-624-8588
Fax Number	:	423-622-3069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	04/05/2010

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