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Individual
DR. KIRBY DWIGHT CLARK
Active
Individual
DR. KIRBY DWIGHT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45690
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-21349
MEDICA CHOICE & PRIMARY
MN
05
—
0567727
—
IA
01
—
1044612
PREFERRED ONE
MN
05
—
128460600
—
MN
01
—
135432
UCARE
MN
01
—
2374581
ARAZ
MN
01
—
676T8CL
BCBS
MN
01
—
A024
CHAMPUS
MN
01
—
HP54853
HEALTHPARTNERS
MN
Enumeration date
06/29/2006
Last updated
07/09/2007
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