=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437683729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | F CLARK SAULS, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2017
-----------------------------------------------------
Last Update Date | 04/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 723 W RANDOLPH AVE SUITE 6
-----------------------------------------------------
City | ENID
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73701-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-237-4085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 W MAPLE AVE SUITE 201
-----------------------------------------------------
City | ENID
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73701-3863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-237-4085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | FIELDING CLARK SAULS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 580-237-4085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084A0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 22288
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------