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General NPI Number Information
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NPI Number | 1679667174
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Entity Type | Individual
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Provider Name | HAL CLIFORD CLARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21556 TIMBERLAKE RD SUITE D
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City | LYNCHBURG
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State | VA
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Zip | 24502
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Country | US
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Telephone | 434-239-8104
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Fax | 434-239-4312
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Provider Business Mailing Address
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Address Line | 207 SHEFFEY DR
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City | FOREST
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State | VA
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Zip | 24551
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Country | US
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Telephone | 434-239-8104
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Fax | 434-239-4312
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101040584
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License Number State | VA
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