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RANDALL BRUCE CLARK D.O. NPI 1265873111


NPI Information

NPI: 1265873111
Provider Name: RANDALL BRUCE CLARK, D.O.
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Organization: PERRY COUNTY HEALTH SYSTEM

PECOS Registration: Yes

Address:
70 DOCTORS PARK
CAPE GIRARDEAU, MO
ZIP 63703
Phone: (573) 334-6071
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Randall Bruce Clark, D.O. is a diagnostic radiology radiology in Cape Girardeau, MO with 11 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Randall Bruce Clark, D.O. NPI is 1265873111. 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:

70 DOCTORS PARK
CAPE GIRARDEAU, MO
ZIP 63703-928
Phone: (573) 334-6071
Fax: (573) 334-4739

The NPI 1265873111 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 enumeration date for this NPI number is 7/8/2013 and was last updated on 1/27/2021.


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
12085R0202XRadiologyDiagnostic Radiology2013021199MISSOURIYes

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.