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Individual
CLARK PETER JOHNSON
Active
Individual
CLARK PETER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901000962
MI
213EP1101X
Primary Podiatric Medicine Podiatrist
5901000962
MI
213ES0131X
Foot Surgery Podiatrist
5901000962
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0980190001
ADMINASTAR DMERC
MI
01
—
121508
PREFERRED CHOICES
MI
05
—
1342674
—
MI
01
—
2730002
PHP IBA
MI
01
—
4851350000
BCBSM
MI
01
—
5212079
AETNA
MI
01
—
P53895
BLUE CARE NETWORK
MI
Enumeration date
03/23/2006
Last updated
08/20/2007
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