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NPI Code Detail

MEDICARE: DR. CLARK W ANTONSON MD

MEDICARE: DR. CLARK W ANTONSON 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
1174400000XSpecialist17282NE
2207RG0100XGastroenterology Physician17282NE

General Provider Information

NPI Number : 1831182757
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLARK W ANTONSON MD
Provider Business Mailing Address
First Line : 4545 R ST
Second Line :
City : LINCOLN
State : NE
Zip : 68503-3723
Country : US
Telephone Number : 402-465-4545
Fax Number : 402-465-3621
Provider Business Practice Location Address
First Line : 4545 R ST
Second Line :
City : LINCOLN
State : NE
Zip : 68503-3723
Country : US
Telephone Number : 402-465-4545
Fax Number : 402-465-3621
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 01/27/2025

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Directions to “ DR. CLARK W ANTONSON MD” Practice Location

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