Healthcare Provider Details

I. General information

NPI: 1831444017
Provider Name (Legal Business Name): JOHN ARNOT CLARK MD., MS (DERM), FRCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 MISSION RIDGE ROAD
SANTA BARBARA CA
93103-1857
US

IV. Provider business mailing address

1849 MISSION RIDGE ROAD
SANTA BARBARA CA
93103-1857
US

V. Phone/Fax

Practice location:
  • Phone: 805-965-0705
  • Fax:
Mailing address:
  • Phone: 805-965-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberGFE13004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberGFE13004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: