GLENN L. CLARK M.D. NPI 1093700320

NPI Information

  • NPI: 1093700320
  • Provider Name: GLENN L. CLARK, M.D.
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Individual
  • Address: 4250 HOSPITAL DR
    MARIANNA, FL
    ZIP 32446
  • Phone: (850) 718-2597

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NPI Details

Glenn L. Clark, M.D. is a diagnostic radiology radiology in Marianna, FL. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Glenn L. Clark, M.D. NPI is 1093700320. 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:

4250 HOSPITAL DR
MARIANNA, FL
ZIP 32446-917
Phone: (850) 718-2597
Fax: (850) 718-2551

The enumeration date for this NPI number is 9/13/2005 and was last updated on 7/8/2007.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0202XRadiologyDiagnostic RadiologyME42096FLORIDAYes

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 Other Provider Identifier Issuer
1C76060MEDICARE UPIN
232068MEDICARE ID-TYPE UNSPECIFIEDFLORIDA

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: 11/21/2025

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