Organization
CLARKE PODIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACEY J. CLARKE DPM (OWNER)
(541) 786-2321
Entity
Organization
Contact information
Practice address
113 S MAIN ST, MILTON FREEWATER, OR 97862-1342
(541) 786-2321
(541) 854-4020
Mailing address
PO BOX 687, MILTON FREEWATER, OR 97862-0687
(541) 786-2321
(541) 854-4020
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DP00283
OR
213ES0131X
Foot Surgery Podiatrist
DP00283
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150541
—
OR
01
—
6805300
BLUE CROSS BLUE SHIELD
OR
Enumeration date
10/11/2017
Last updated
03/07/2023
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