TIMOTHY DALE CLARK CCP NPI 1831226604

NPI Information

Timothy Dale Clark, CCP is a durable medical equipment medical supplies in Gainesville, FL. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time. Timothy Dale Clark, CCP NPI is 1831226604. 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:

1600 SW ARCHER RD
SUITE NG-28
GAINESVILLE, FL
ZIP 32610-003
Phone: (352) 665-1209
Fax: (352) 332-3761

The enumeration date for this NPI number is 2/27/2007 and was last updated on 7/9/2007.

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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