Individual
DR. LIN W CLARK
Active
Individual
DR. LIN W CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
65768
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168073
COVENTRY
—
01
—
18018041
BLUE CROSS BLUE SHIELD
MO
01
—
7896043
AETNA
—
01
—
R5P28
STATE LICENSE NUMBER
MO
Enumeration date
10/04/2006
Last updated
08/07/2024
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