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NPI Code Detail

MEDICARE: DR. BLISS WATSON CLARK II M.D.

MEDICARE: DR. BLISS WATSON CLARK II 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
1207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianG59282CA

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 : 1447258272
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BLISS WATSON CLARK II M.D.
Provider Business Mailing Address
First Line : 1541 FLORIDA AVE
Second Line : SUITE 200
City : MODESTO
State : CA
Zip : 95350-4423
Country : US
Telephone Number : 209-214-7053
Fax Number : 209-523-0764
Provider Business Practice Location Address
First Line : 1262 E NORTH ST
Second Line :
City : MANTECA
State : CA
Zip : 95336-4962
Country : US
Telephone Number : 209-214-7053
Fax Number : 209-523-0764
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 11/05/2011

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