MEDICARE: DR. STANLEY CORBIN 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	208800000X	Urology Physician	172492-1205	UT

General Provider Information

NPI Number	:	1770591620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY CORBIN CLARK MD

Provider Business Mailing Address
First Line	:	9690 S 1300 E
Second Line	:	100
City	:	SANDY
State	:	UT
Zip	:	84094-3721
Country	:	US
Telephone Number	:	801-571-5121
Fax Number	:	801-572-5358

Provider Business Practice Location Address
First Line	:	9690 S 1300 E
Second Line	:	100
City	:	SANDY
State	:	UT
Zip	:	84094-3721
Country	:	US
Telephone Number	:	801-571-5121
Fax Number	:	801-572-5358

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	05/08/2012

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Directions to “ DR. STANLEY CORBIN CLARK MD” Practice Location

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