Individual
DR. MICHAEL S CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3150 S NATIONAL AVE, SPRINGFIELD, MO 65807-7301
(417) 881-5529
(417) 885-3921
Mailing address
3150 S NATIONAL AVE, SPRINGFIELD, MO 65807-7301
(417) 881-5529
(417) 885-3921
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
32388
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200505824
—
MO
01
—
201077503
PALMETTO GBA
—
01
—
431552300
TRICARE WEST
—
Enumeration date
07/13/2005
Last updated
08/08/2008
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