Individual
DR. JAMES M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
700 S MAIN ST, MOSCOW, ID 83843
(208) 882-4511
Mailing address
700 S MAIN ST, MOSCOW, ID 83843-3046
(208) 882-4511
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
O-272
ID
207P00000X
Emergency Medicine Physician
OP00001738
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578523577
—
ID
05
—
1578523577
—
MT
05
—
1578523577
—
WA
05
—
806111700
—
ID
Enumeration date
03/24/2006
Last updated
04/16/2019
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