Individual
DR. DAVID W CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11104 PARKVIEW CIRCLE DR, SUITE 310, FORT WAYNE, IN 46845-1672
(260) 266-5230
(260) 266-5238
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9965
(260) 458-5664
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01037790
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000672225
ANTHEM
IN
05
—
200015230
—
IN
Enumeration date
05/06/2006
Last updated
10/10/2013
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