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DR. DWAYNE CHARLES CLARK MD NPI 1184695975


NPI Information

NPI: 1184695975
Provider Name: DR. DWAYNE CHARLES CLARK, MD
Classification: Family Medicine - 207Q00000X
Entity Type: Individual
Organization: AGNESIAN HEALTHCARE INC

PECOS Registration: Yes

Address:
723 PARK RIDGE LN
N FOND DU LAC, WI
ZIP 54937
Phone: (920) 926-8600
Get Directions

DR. Dwayne Charles Clark, MD is a family medicine in N Fond Du Lac, WI with 30 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Dwayne Charles Clark, MD NPI is 1184695975. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: DUKE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1994

The provider's business location address is:

723 PARK RIDGE LN
N FOND DU LAC, WI
ZIP 54937-385
Phone: (920) 926-8600
Fax: (920) 926-8650

The NPI 1184695975 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), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Pneumococcal vaccine for injection into muscle (HCPCS:90670)
  • Administration of pneumococcal vaccine (HCPCS:G0009)
  • Routine EKG using at least 12 leads including interpretation and report (HCPCS:93000)
  • X-ray of chest, 2 views, front and side (HCPCS:71020)

The enumeration date for this NPI number is 1/30/2006 and was last updated on 10/28/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine48855WISCONSINYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1P00319962OTHERWISCONSINRAILROAD MEDICARE

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: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.