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NPI Code Detail

MEDICARE: DR. CHARLES SPURGEON CLARK JR. M.D.

MEDICARE: DR. CHARLES SPURGEON CLARK JR. 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
1207R00000XInternal Medicine Physician338282LA

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 : 1720425416
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES SPURGEON CLARK JR. M.D.
Provider Business Mailing Address
First Line : 3530 HOUMA BLVD STE 300
Second Line :
City : METAIRIE
State : LA
Zip : 70006-4203
Country : US
Telephone Number : 504-264-5142
Fax Number : 504-455-2648
Provider Business Practice Location Address
First Line : 4605 MAGAZINE ST
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70115-1517
Country : US
Telephone Number : 504-842-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2013
Last Update Date : 03/11/2026

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