Individual
DR. HOLLY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1250 E 3900 S, SUITE 360, SALT LAKE CITY, UT 84124-1348
(801) 263-3041
(801) 263-8485
Mailing address
6360 S 3000 E, #220, SALT LAKE CITY, UT 84121-6923
(801) 263-3041
(801) 263-8485
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
4977163
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49771631200001
BLUE CROSS BLUE SHIELD
UT
01
—
78498
PUBLIC EMPLOYEES
UT
01
—
QM0000217387
ALTIUS
UT
Enumeration date
10/04/2006
Last updated
06/09/2015
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