MEDICARE: DAVID B CLARK 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	208D00000X	General Practice Physician	2003015259	MO
2	207L00000X	Anesthesiology Physician	2003015259	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2002364	OTHER	MO	UNITED HEALTHCARE
2	145402	OTHER	MO	HEALTHLINK
3	127254	OTHER	MO	BLUE CHOICE
4	127254	OTHER	MO	BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811952385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID B CLARK MD

Provider Business Mailing Address
First Line	:	9051 WATSON RD
Second Line	:	#263
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-2240
Country	:	US
Telephone Number	:	314-667-5397
Fax Number	:	314-627-0767

Provider Business Practice Location Address
First Line	:	9051 WATSON RD
Second Line	:	#263
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-2240
Country	:	US
Telephone Number	:	314-667-5397
Fax Number	:	314-627-0767

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	03/26/2013

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Directions to “ DAVID B CLARK MD” Practice Location

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