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General NPI Number Information
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NPI Number | 1104829688
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Entity Type | Individual
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Provider Name | STANLEY D CLARKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 1110 S JACKSON HWY
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City | SHEFFIELD
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State | AL
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Zip | 35660-5747
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Country | US
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Telephone | 256-383-5211
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Fax | 256-381-1517
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Provider Business Mailing Address
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Address Line | 15055 COLLECTION CENTER DR
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City | CHICAGO
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State | IL
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Zip | 60693-0001
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Country | US
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Telephone | 256-383-3325
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Fax | 480-212-8451
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 00019049
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License Number State | AL
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