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Individual

DR. LOUIS PHILLIP CLARK JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4140 FERNCREEK DR, SUITE 801, FAYETTEVILLE, NC 28314-2563
(910) 484-2171
(910) 484-4568
Mailing address
4140 FERNCREEK DR, SUITE 801, FAYETTEVILLE, NC 28314-2563
(910) 484-2171
(910) 484-4568

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
27779
NC
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
27779
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
22718
BCBS INDIVIDUAL ID NUMBER
NC
05
8922718
NC
Enumeration date
02/15/2006
Last updated
10/05/2012
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