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Individual
DR. SHANNON CLARK
Active
Individual
DR. SHANNON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A103021
CA
207VX0000X
Obstetrics Physician
A103021
CA
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
A103121
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
MEDICAL
CA
Enumeration date
09/26/2007
Last updated
07/17/2012
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