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Individual
GREGORY JAMES CLARK
Active
Individual
GREGORY JAMES CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD-43163
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101225800
—
MN
01
—
110164901
RR MEDICARE
MN
01
—
115522
UCARE
MN
05
—
1942185
—
IA
01
—
8T180CL
BCBS MPIN
MN
Enumeration date
10/04/2006
Last updated
07/21/2022
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