Individual
CHARLES R CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-2332
(319) 353-6754
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-2332
(319) 353-6754
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
22081
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0170613
—
IA
01
—
17061
WELLMARK BCBS
IA
Enumeration date
08/24/2005
Last updated
11/28/2007
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