Individual
JOHN M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4401 HARRISON BLVD, OGDEN, UT 84403-3195
(801) 387-4300
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-4300
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
1578301205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157830-1205
PROFESSIONAL STATE LICENSE
UT
Enumeration date
08/14/2006
Last updated
05/03/2010
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