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General NPI Number Information
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NPI Number | 1457422172
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Entity Type | Organization
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Legal Business Name | KAREN A CLARK MD PA
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 2450 E SHOW LOW LAKE RD 2A
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City | SHOW LOW
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State | AZ
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Zip | 85901-7953
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Country | US
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Telephone | 928-537-1070
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Fax | 928-537-1064
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Provider Business Mailing Address
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Address Line | 2450 E SHOW LOW LAKE RD 2A
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City | SHOW LOW
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State | AZ
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Zip | 85901-7953
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Country | US
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Telephone | 928-537-1070
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Fax | 928-537-1064
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN A CLARK
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Credential | MD
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Telephone | 928-537-1070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 32348
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License Number State | AZ
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