MEDICARE: GUY 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
1	207RR0500X	Rheumatology Physician	G1009A	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1063574788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUY CLARK MD

Provider Business Mailing Address
First Line	:	2419 CASTILLO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4301
Country	:	US
Telephone Number	:	805-682-7570
Fax Number	:	805-687-3776

Provider Business Practice Location Address
First Line	:	2419 CASTILLO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4301
Country	:	US
Telephone Number	:	805-682-7570
Fax Number	:	805-687-3776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	07/09/2007

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Directions to “ GUY CLARK MD” Practice Location

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