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General NPI Number Information
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NPI Number | 1396743951
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Entity Type | Individual
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Provider Name | PETER L CLARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 609 MCFARLAND ST
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City | MORRISTOWN
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State | TN
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Zip | 37814-3976
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Country | US
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Telephone | 423-714-0714
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Fax | 423-587-3799
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Provider Business Mailing Address
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Address Line | 609 MCFARLAND ST
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City | MORRISTOWN
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State | TN
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Zip | 37814-3976
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Country | US
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Telephone | 423-585-0442
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Fax | 423-586-2146
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 18105
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License Number State | TN
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