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Individual
DR. ELIZABETH TALLEY CLARK
Active
Individual
DR. ELIZABETH TALLEY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., R.V.T.
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
036-076927
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-076927-1
—
IL
01
—
1487646535
NPI
IL
Enumeration date
08/16/2005
Last updated
04/24/2015
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