Individual
DR. HENRY BUSHNELL CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
603 7TH ST S, SUITE 540, ST PETERSBURG, FL 33701-4734
(727) 553-7550
(727) 553-7549
Mailing address
PO BOX 10744, CLEARWATER, FL 33757-8744
(727) 532-0002
(727) 266-4943
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
ME0059894
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054928200
—
FL
01
—
P00647724
RAILROAD MEDICARE PROVIDER NUMBER
FL
Enumeration date
06/27/2006
Last updated
04/25/2017
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