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Individual
WILLIAM MATT CLARK
Active
Individual
WILLIAM MATT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
170625-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107010384101
IHC
UT
01
—
17965
PEHP
UT
01
—
2000040
UNITED HEALTHCARE
UT
01
—
2430
HEALTHY U
UT
05
—
401765
—
MT
01
—
416932
DESERET MUTUAL
UT
01
—
870280408CL2
EDUCATORS MUTUAL
UT
01
—
PRA01666
MOLINA
UT
01
—
QM0000049510
ALTIUS
UT
Enumeration date
08/20/2006
Last updated
07/08/2007
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