Individual
DR. CRAIG D CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
825 NW HIGHWAY 101 STE A, LINCOLN CITY, OR 97367-3241
(541) 996-7480
Mailing address
PO BOX 1194, CORVALLIS, OR 97339-1194
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2017-00085
NC
207X00000X
Orthopaedic Surgery Physician
8253
NV
207X00000X
Orthopaedic Surgery Physician
Primary
MD199243
OR
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
2017-00085
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002002817
—
NV
01
—
200034313
RAILROAD MEDICARE
NV
Enumeration date
08/05/2006
Last updated
11/04/2020
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