Individual
CHAD JEREMY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
900 ROUND VALLEY DR, SUITE 200, PARK CITY, UT 84060-7552
(435) 658-7400
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
(719) 330-7854
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
46699
CO
207V00000X
Obstetrics & Gynecology Physician
Primary
8984876-1204
UT
207V00000X
Obstetrics & Gynecology Physician
DOS994
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46699
LICENSE
CO
Enumeration date
10/12/2006
Last updated
04/20/2023
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