MEDICARE: DR. SHAWN B 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
1	207T00000X	Neurological Surgery Physician	23993	AL

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	:	1306849575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN B CLARK M.D.

Provider Business Mailing Address
First Line	:	6701 AIRPORT BLVD STE D146
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-3784
Country	:	US
Telephone Number	:	251-287-2176
Fax Number	:	251-287-2279

Provider Business Practice Location Address
First Line	:	6701 AIRPORT BLVD STE D146
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-3784
Country	:	US
Telephone Number	:	251-287-2176
Fax Number	:	251-287-2279

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/17/2017

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