MEDICARE: MR. MARK B CLINGER MD - FAMILY PRACTICE

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	207Q00000X	Family Medicine Physician	M-10219	ID

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

General Provider Information

NPI Number	:	1699769471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK B CLINGER MD - FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	215 E HAWAII AVE
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6011
Country	:	US
Telephone Number	:	208-463-3000
Fax Number	:	208-463-3064

Provider Business Practice Location Address
First Line	:	9850 W ST LUKES DR STE 229
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-7912
Country	:	US
Telephone Number	:	208-463-3000
Fax Number	:

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	11/17/2022

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