=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629606249
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARK IAN ANDREWS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2020
-----------------------------------------------------
Last Update Date | 07/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3126 N CIVIC CENTER PLZ
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-874-2040
-----------------------------------------------------
Fax | 480-355-0787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3126 N CIVIC CENTER PLZ
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-6912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-874-2040
-----------------------------------------------------
Fax | 480-355-0787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 75997-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 76078
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------