MEDICARE: WILLIAM R CLARK II

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	208800000X	Urology Physician	MD61117110	WA
2	208800000X	Urology Physician	AK1625	AK

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	:	1073567079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R CLARK II

Provider Business Mailing Address
First Line	:	188 W NORTHERN LIGHTS BLVD
Second Line	:	SUITE 800
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-3902
Country	:	US
Telephone Number	:	907-276-2803
Fax Number	:	907-278-8052

Provider Business Practice Location Address
First Line	:	188 W NORTHERN LIGHTS BLVD
Second Line	:	SUITE 800
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-3902
Country	:	US
Telephone Number	:	907-276-2803
Fax Number	:	907-278-8052

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	11/11/2021

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Directions to “ WILLIAM R CLARK II ” Practice Location

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