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Individual
ELOISE MARIE CLARK
Active
Individual
ELOISE MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
47488
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058453300
—
MN
01
—
0704419
MEDICA #
MN
05
—
13554
—
MN
01
—
137002
UCARE #
MN
01
—
2364648
AMERICA'S PPO/ARAZ #
MN
01
—
25707
NDBS #
FM
01
—
300S9CL
MNBS #
MN
01
—
43201
LHS/BANNERHEALTH #
FM
01
—
DA9021044062
PREFERRED ONE #
MN
01
—
HP53190
HEALTHPARTNERS #
MN
Enumeration date
06/06/2006
Last updated
01/06/2012
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