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General NPI Number Information
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NPI Number | 1700864238
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Entity Type | Individual
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Provider Name | WALTER D CLARK DPM
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 805 ST. VINCENT'S DRIVE SUITE 420
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City | BIRMINGHAM
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State | AL
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Zip | 35205-2704
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Country | US
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Telephone | 205-324-8511
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Fax | 205-314-8551
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Provider Business Mailing Address
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Address Line | 805 ST. VINCENT'S DRIVE SUITE 420
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City | BIRMINGHAM
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State | AL
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Zip | 35205-2704
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Country | US
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Telephone | 205-324-8511
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Fax | 205-314-8551
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0048
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License Number State | AL
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