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NPI Code Detail

MEDICARE: DR. PATRICIA L CLARK MD

MEDICARE: DR. PATRICIA L CLARK MD
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
1208600000XSurgery Physician01094461AIN
2208600000XSurgery Physician51951AZ

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 : 1053335349
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICIA L CLARK MD
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11050 PARKVIEW CIRCLE DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1739
Country : US
Telephone Number : 833-724-8326
Fax Number : 260-425-6845
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 10/02/2024

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Directions to “ DR. PATRICIA L CLARK MD” Practice Location

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