Individual
EDGAR T CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
77 W FOREST AVE, SUITE 101, FLAGSTAFF, AZ 86001-1479
(928) 773-2515
(928) 773-2240
Mailing address
DEPT 2018, PO BOX 29675, PHOENIX, AZ 85038-9675
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
7408
AZ
2085R0202X
Diagnostic Radiology Physician
Primary
7408
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053783
—
CA
05
—
053783
—
IA
05
—
235813
—
AZ
05
—
8602594002/Z1339
—
UT
05
—
B8407
—
NM
Enumeration date
05/24/2006
Last updated
05/09/2008
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