Individual
WILLIAM M CLARK JR.
Active
Individual
WILLIAM M CLARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
336 040184
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01615704
BLUE CROSS
IL
05
—
0360770
—
IL
01
—
260041526
RAILROAD
IL
Enumeration date
08/10/2006
Last updated
07/13/2010
Update your record
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