Individual
ANNE C CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01031207
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000538214
BLUE CROSS/BLUE SHIELD
IN
05
—
100326110
—
IN
Enumeration date
11/08/2006
Last updated
01/05/2008
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