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General NPI Number Information
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NPI Number | 1679801229
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Entity Type | Organization
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Legal Business Name | MATTHEW HOUSTON CLARK MD INC
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 520 SUPERIOR AVE SUITE 225
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3637
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Country | US
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Telephone | 949-360-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 520 SUPERIOR AVE SUITE 225
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3637
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Country | US
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Telephone | 949-360-0300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW H. CLARK
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Credential | M.D.
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Telephone | 949-360-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number |
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License Number State |
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