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General NPI Number Information
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NPI Number | 1700273836
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Entity Type | Individual
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Provider Name | MELVIN CLARK III C.C.M.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 417 SW 9TH ST
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City | DELRAY BEACH
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State | FL
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Zip | 33444-2331
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Country | US
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Telephone | 561-901-5525
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 OCEANVIEW AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-4373
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Country | US
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Telephone | 561-901-5525
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | FL43256
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License Number State | FL
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