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General NPI Number Information
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NPI Number | 1861519415
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Entity Type | Individual
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Provider Name | STEVE RUSSELL CLARKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 2801 SANTA MARIA WAY SUITE A
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City | SANTA MARIA
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State | CA
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Zip | 93455-2118
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Country | US
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Telephone | 805-934-5400
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Fax | 805-938-9207
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Provider Business Mailing Address
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Address Line | 2050 S BLOSSER RD
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City | SANTA MARIA
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State | CA
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Zip | 93458-7310
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Country | US
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Telephone | 805-361-8028
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Fax | 805-361-8097
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G 62802
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License Number State | CA
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