Individual
DR. DAVID A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4600 LAKE BOONE TRAIL, SUITE 100, RALEIGH, NC 27607-7529
(919) 787-1374
(919) 788-9007
Mailing address
4600 LAKE BOONE TRAIL, SUITE 100, RALEIGH, NC 27607-7529
(919) 787-1374
(919) 788-9007
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
35295
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040010474
RAILROAD MEDICARE
NC
01
—
1050087
UNITED HEALTHCARE
NC
01
—
22601
BLUE CROSS
NC
05
—
8922601
—
NC
Enumeration date
05/05/2006
Last updated
07/12/2021
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