Individual
DR. DAVID W CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12300 METCALF AVE, OVERLAND PARK, KS 66213-1324
(913) 317-7485
Mailing address
PO BOX 411039, KANSAS CITY, MO 64141-1039
(913) 234-1350
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
04-27540
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01674018
BCBS OF KC MO GROUP ID #
KS
05
—
100317940A
—
KS
05
—
100317940C
—
KS
05
—
208678029
—
MO
01
—
25062057
BCBS OF KC MO
MO
01
—
25062077
BCBS KC MO
MO
01
—
930066218
RR MEDICARE GROUP CG8899
—
01
—
P00188856
RR MEDICARE GROUP DC6712
—
Enumeration date
08/03/2005
Last updated
07/14/2008
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