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General NPI Number Information
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NPI Number | 1801982939
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Entity Type | Individual
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Provider Name | DOUGLAS L CLARK MD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 2116 W FAIDLEY AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4678
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Country | US
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Telephone | 308-398-5996
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Fax | 308-398-5333
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Provider Business Mailing Address
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Address Line | 2116 W FAIDLEY AVE SAINT FRANCIS MEDICAL CENTER
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4678
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Country | US
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Telephone | 308-398-5996
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Fax | 308-398-5333
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 26077
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 12230
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 35899
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 27361
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License Number State | NE
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