MEDICARE: WILLIAM HENRY CLARK

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	207R00000X	Internal Medicine Physician	7474	AZ

General Provider Information

NPI Number	:	1598838799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM HENRY CLARK

Provider Business Mailing Address
First Line	:	2121 N BEVERLY AVE STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2154
Country	:	US
Telephone Number	:	520-323-7026
Fax Number	:	520-323-0301

Provider Business Practice Location Address
First Line	:	2121 N BEVERLY AVE STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2154
Country	:	US
Telephone Number	:	520-323-7026
Fax Number	:	520-323-0301

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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Directions to “ WILLIAM HENRY CLARK ” Practice Location

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