Healthcare Provider Details

I. General information

NPI: 1790472058
Provider Name (Legal Business Name): ERIN CLARK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE
AURORA CO
80045-7106
US

IV. Provider business mailing address

PEDIATRIC EDUCATION OFFICE CAMPUS BOX 7593
CHAPEL HILL NC
27599-7593
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-6857
  • Fax: 720-777-7207
Mailing address:
  • Phone: 919-966-3172
  • Fax: 984-974-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0077596
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: