Healthcare Provider Details

I. General information

NPI: 1528315835
Provider Name (Legal Business Name): MATTHEW E.A. CLARKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 PACIFIC AVE
LONG BEACH CA
90806-6113
US

IV. Provider business mailing address

24200 WALNUT ST SPC 108
TORRANCE CA
90501-6737
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-4718
  • Fax: 562-591-7323
Mailing address:
  • Phone: 424-653-9547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA134249
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA134249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: