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Individual

DR. JOSEPH HUSTON CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
301 E WENDOVER AVE, STE 311, GREENSBORO, NC 27401-1230
(336) 272-6161
Mailing address
301 E WENDOVER AVE, STE 311, GREENSBORO, NC 27401-1230
(336) 272-6161

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
200500021
NC
2080P0206X
Pediatric Gastroenterology Physician
Primary
200500021
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1386T
BCBS NC
NC
01
4304710
AETNA
NC
05
5900510
NC
01
B1041
MEDCOST
NC
Enumeration date
05/05/2006
Last updated
04/15/2013
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