Individual
DR. KEVIN CLARK ISIDRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
250 E DUNLAP AVE, PHOENIX, AZ 85020-2825
(602) 445-0751
(602) 424-8128
Mailing address
9225 N 3RD ST STE 300, PHOENIX, AZ 85020-2466
(602) 445-0751
(602) 424-8128
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
65147
AZ
207R00000X
Internal Medicine Physician
R77280
AZ
208M00000X
Hospitalist Physician
65147
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154017
—
AZ
01
—
65147
AZ MD LICENSE
AZ
Enumeration date
04/09/2019
Last updated
06/27/2022
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