DR. CLINTON H CLARK DPM NPI 1710924345

NPI Information

DR. Clinton H Clark, DPM is a foot and ankle surgery podiatrist in Meridian, ID with 37 years of experience. DR. Clinton H Clark, DPM NPI is 1710924345. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: TEMPLE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1987

The provider's business location address is:

520 S EAGLE RD
STE 1243
MERIDIAN, ID
ZIP 83642-351
Phone: (208) 938-4670

The NPI 1710924345 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 6/1/2006 and was last updated on 2/21/2014.

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:

Other Identifiers

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

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