Individual
G GREGORY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9002 N MERIDIAN ST, SUITE 112, INDIANAPOLIS, IN 46260-5381
(317) 843-9005
(317) 580-0443
Mailing address
9002 N MERIDIAN ST, SUITE 112, INDIANAPOLIS, IN 46260-5381
(317) 843-9005
(317) 580-0443
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0132124A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000538215
BLUE CROSS/BLUE SHIELD
IN
05
—
100326120
—
IN
Enumeration date
11/08/2006
Last updated
01/05/2008
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