MEDICARE: JAMES EDWARD 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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1801746391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EDWARD CLARK

Provider Business Mailing Address
First Line	:	18470 W SAGUARO LN
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85388-2354
Country	:	US
Telephone Number	:	626-318-6981
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 N 40TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-6486
Country	:	US
Telephone Number	:	602-797-7700
Fax Number	:

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	06/15/2026

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Directions to “ JAMES EDWARD CLARK ” Practice Location

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