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General NPI Number Information
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NPI Number | 1013307602
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Entity Type | Organization
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Legal Business Name | JOHN M CLARK MD
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 3860 TEAYS VALLEY RD STE 4
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City | HURRICANE
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State | WV
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Zip | 25526-9772
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Country | US
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Telephone | 304-201-2545
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Fax | 304-201-2548
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Provider Business Mailing Address
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Address Line | 3860 TEAYS VALLEY RD STE 4
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City | HURRICANE
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State | WV
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Zip | 25526-9772
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Country | US
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Telephone | 304-201-2545
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Fax | 304-201-2548
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JOHN M CLARK
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Credential | M.D.
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Telephone | 304-201-2545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | WV
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