Individual
DOUGLAS L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2116 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4678
(308) 398-5996
(308) 398-5333
Mailing address
2116 W FAIDLEY AVE, SAINT FRANCIS MEDICAL CENTER, GRAND ISLAND, NE 68803-4678
(308) 398-5996
(308) 398-5333
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
12230
ND
2085R0001X
Radiation Oncology Physician
26077
OK
2085R0001X
Radiation Oncology Physician
Primary
27361
NE
2085R0001X
Radiation Oncology Physician
35899
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200134920A
—
OK
Enumeration date
10/05/2006
Last updated
09/03/2014
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