Individual
WILLIAM MATT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 588-3272
(801) 588-3279
Mailing address
1954 FORT UNION BLVD, 111, SALT LAKE CITY, UT 84121-6800
(801) 993-9551
(801) 733-5872
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
170625-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107010384101
IHC
UT
01
—
17965
PEHP
UT
01
—
2000040
UNITED HEALTHCARE
UT
01
—
2430
HEALTHY U
UT
05
—
401765
—
MT
01
—
416932
DESERET MUTUAL
UT
01
—
870280408CL2
EDUCATORS MUTUAL
UT
01
—
PRA01666
MOLINA
UT
01
—
QM0000049510
ALTIUS
UT
Enumeration date
08/20/2006
Last updated
07/08/2007
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