MEDICARE: DR. WILLIAM GILMER 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	207Q00000X	Family Medicine Physician	24323	NC

General Provider Information

NPI Number	:	1528047503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM GILMER CLARK MD

Provider Business Mailing Address
First Line	:	12418 DUNARD ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6959
Country	:	US
Telephone Number	:	919-554-8868
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 S MAIN ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-5011
Country	:	US
Telephone Number	:	919-570-2000
Fax Number	:	919-570-2001

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	10/25/2020

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