Healthcare Provider Details

I. General information

NPI: 1417906181
Provider Name (Legal Business Name): CLARK WHITELEY SHEFFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 N UNIVERSITY AVE STE 250
PROVO UT
84604-6695
US

IV. Provider business mailing address

3550 N UNIVERSITY AVE STE 250
PROVO UT
84604-6685
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-3460
  • Fax: 801-852-3459
Mailing address:
  • Phone: 801-374-9625
  • Fax: 801-373-7506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number353117-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: