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General NPI Number Information
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NPI Number | 1801938881
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Entity Type | Organization
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Legal Business Name | STEPHEN J. CLARK, M.D., INC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 3798 JANES RD SUITE 7
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City | ARCATA
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State | CA
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Zip | 95521-4753
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Country | US
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Telephone | 707-825-7765
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 496084
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City | REDDING
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State | CA
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Zip | 96049-6084
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Country | US
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Telephone | 530-241-0473
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Fax | 530-241-5377
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN J. CLARK
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Credential | M.D.
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Telephone | 707-825-7765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | G86858
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License Number State | CA
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