Individual
MRS. ELEANOR ANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1780 E FLORENCE BLVD, SUITE 108, CASA GRANDE, AZ 85122-4782
(520) 381-6758
(520) 381-6040
Mailing address
1780 E FLORENCE BLVD STE 108, CASA GRANDE, AZ 85122-4782
(520) 381-6758
(520) 381-6040
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
16389
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243139
—
AZ
Enumeration date
08/09/2005
Last updated
08/18/2014
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