Healthcare Provider Details

I. General information

NPI: 1124720024
Provider Name (Legal Business Name): ALEX CLARKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 N BUSINESS ROUTE 5
CAMDENTON MO
65020-2659
US

IV. Provider business mailing address

1930 N BUSINESS ROUTE 5
CAMDENTON MO
65020-2659
US

V. Phone/Fax

Practice location:
  • Phone: 573-346-5624
  • Fax: 573-346-1957
Mailing address:
  • Phone: 573-346-5624
  • Fax: 573-346-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026013113
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: