Healthcare Provider Details

I. General information

NPI: 1235870460
Provider Name (Legal Business Name): RACHAEL CLARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MARIO CAPECCHI DR 5S126
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 N MARIO CAPECCHI DR 5S126
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-9299
  • Fax:
Mailing address:
  • Phone: 801-213-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VC0300X
TaxonomyComplex Family Planning Physician
License Number14277762-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14277762-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: