Individual
ELIZABETH CATHERINE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
200 W. HOSPITAL DR, WHITERIVER, AZ 85941
(928) 338-4911
Mailing address
PO BOX 860, WHITERIVER, AZ 85941-0860
(928) 338-4911
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
1346
WV
207Q00000X
Family Medicine Physician
Primary
1346
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295993376
—
AZ
05
—
1629236716
—
AZ
05
—
1780614008
—
AZ
05
—
1871523191
—
AZ
05
—
409757
—
AZ
Enumeration date
07/31/2006
Last updated
12/18/2008
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