Individual
DR. DOUGLAS OWEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21010 BLACK WALNUT LN, A, BROOKFIELD, WI 53045-4062
(262) 780-0594
Mailing address
2418 E BLUEJAY BLUFF LN, A, GREEN VALLEY, AZ 85614-5568
(414) 791-6184
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
16533
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
WI
Enumeration date
10/07/2010
Last updated
05/19/2016
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