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NPI Code Detail

MEDICARE: DR. CHAD LEROY CLARK M.D.

MEDICARE: DR. CHAD LEROY CLARK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianA70662CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023052545
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAD LEROY CLARK M.D.
Provider Business Mailing Address
First Line : PO BOX 661987
Second Line :
City : ARCADIA
State : CA
Zip : 91066-1987
Country : US
Telephone Number : 626-447-0296
Fax Number : 626-447-6057
Provider Business Practice Location Address
First Line : 3865 JACKSON ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-3919
Country : US
Telephone Number : 951-352-5666
Fax Number : 951-352-5445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 06/13/2008

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