Individual
DR. JAMES W CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1885 PLAZA DR, EAGAN, MN 55122-2612
(952) 993-4001
Mailing address
3800 PARK NICOLLET BLVD, CREDENTIALING, ST LOUIS PARK, MN 55416-2527
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
26114
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
444703400
—
MN
Enumeration date
01/01/2006
Last updated
03/01/2012
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