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NPI Code Detail

MEDICARE: CHRISTOPHER CLARK M.D.

MEDICARE: CHRISTOPHER CLARK M.D.
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
1207V00000XObstetrics & Gynecology PhysicianMD21512OR

General Provider Information

NPI Number : 1326042912
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER CLARK M.D.
Provider Business Mailing Address
First Line : 2400 NE NEFF RD STE A
Second Line :
City : BEND
State : OR
Zip : 97701-6752
Country : US
Telephone Number : 541-389-3300
Fax Number :
Provider Business Practice Location Address
First Line : 2400 NE NEFF RD STE A
Second Line :
City : BEND
State : OR
Zip : 97701-6752
Country : US
Telephone Number : 541-389-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 01/18/2012

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Directions to “ CHRISTOPHER CLARK M.D.” Practice Location

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