EDGAR T CLARK M.D. NPI 1295780401

NPI Information

NPI: 1295780401
Provider Name: EDGAR T CLARK, M.D.
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Address:
77 W FOREST AVE
SUITE 101
FLAGSTAFF, AZ
ZIP 86001
Phone: (928) 773-2515
Get Directions

Edgar T Clark, M.D. is a diagnostic radiology radiology in Flagstaff, AZ. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Edgar T Clark, M.D. NPI is 1295780401. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

77 W FOREST AVE
SUITE 101
FLAGSTAFF, AZ
ZIP 86001-479
Phone: (928) 773-2515
Fax: (928) 773-2240

The enumeration date for this NPI number is 5/24/2006 and was last updated on 5/9/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207U00000X	Nuclear Medicine		7408	ARIZONA	No
2	2085R0202X	Radiology	Diagnostic Radiology	7408	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	D36678	MEDICARE UPIN
2	300029939	MEDICARE PIN	ARIZONA
3	053783	MEDICAID	IOWA
4	B8407	MEDICAID	NEW MEXICO
5	8602594002/Z1339	MEDICAID	UTAH
6	Z72175	MEDICARE PIN	ARIZONA
7	Z30WCGJX01	MEDICARE PIN	ARIZONA
8	235813	MEDICAID	ARIZONA
9	053783	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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