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General NPI Number Information
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NPI Number | 1275517831
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Entity Type | Individual
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Provider Name | CHAD MICHAEL CLARK MD
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Gender | Male
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 1155 MILL ST
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City | RENO
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State | NV
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Zip | 89502-1576
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Country | US
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Telephone | 775-982-5000
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Fax | 775-982-3900
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Provider Business Mailing Address
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Address Line | PO BOX 7055
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City | RENO
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State | NV
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Zip | 89510-7055
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Country | US
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Telephone | 704-867-8021
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Fax | 704-864-4606
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25106
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License Number State | NV
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