Individual
GREGORY JAMES CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD-43163
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101225800
—
MN
01
—
110164901
RR MEDICARE
MN
01
—
115522
UCARE
MN
05
—
1942185
—
IA
01
—
8T180CL
BCBS MPIN
MN
Enumeration date
10/04/2006
Last updated
07/21/2022
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