Individual
DR. GORDON BLAKE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21624 MIDLAND DR, SHAWNEE, KS 66218-9064
(913) 643-0075
(913) 643-0077
Mailing address
21624 MIDLAND DR, SHAWNEE, KS 66218-9064
(913) 643-0075
(913) 643-0077
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
KS 04-23518
KS
207VB0002X
Obesity Medicine (Obstetrics & Gynecology) Physician
Primary
04-23518
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100305190D
—
KS
Enumeration date
01/19/2006
Last updated
11/02/2011
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