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NPI Code Detail

MEDICARE: DR. PETER L CLARK M.D.

MEDICARE: DR. PETER L 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
1207V00000XObstetrics & Gynecology Physician18105TN

General Provider Information

NPI Number : 1396743951
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER L CLARK M.D.
Provider Business Mailing Address
First Line : 609 MCFARLAND ST
Second Line :
City : MORRISTOWN
State : TN
Zip : 37814-3976
Country : US
Telephone Number : 423-585-0442
Fax Number : 423-586-2146
Provider Business Practice Location Address
First Line : 609 MCFARLAND ST
Second Line :
City : MORRISTOWN
State : TN
Zip : 37814-3976
Country : US
Telephone Number : 423-714-0714
Fax Number : 423-587-3799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 03/12/2024

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