Individual
MR. FRED ELTON CLARK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4401 4TH ST N, SAINT PETERSBURG, FL 33703-4728
(727) 525-4401
(727) 525-7788
Mailing address
4401 4TH ST N, SAINT PETERSBURG, FL 33703-4728
(727) 525-4401
(727) 525-7788
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME102187
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137000
—
FL
01
—
7A6EU
BCBS
FL
Enumeration date
08/18/2008
Last updated
04/18/2017
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