Individual
JAMES PAUL CLARK II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3411A NOYES AVE SE, CHARLESTON, WV 25304
(304) 344-2459
(304) 345-1336
Mailing address
3411A NOYES AVE SE, CHARLESTON, WV 25304
(304) 344-2459
(304) 345-1336
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
17504
WV
207KA0200X
Allergy Physician
17504
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001722434
BLUE CROSS BS
WV
05
—
0079196000
—
WV
01
—
5720204
AETNA
WV
Enumeration date
08/16/2005
Last updated
10/24/2018
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