Organization
JILL E CLARK MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL E CLARK MD (PRESIDENT)
(801) 263-1621
Entity
Organization
Contact information
Practice address
1220 E 3900 S, STE 4I, SALT LAKE CITY, UT 84124-1377
(801) 263-1621
(801) 263-1647
Mailing address
1220 E 3900 S, STE 4I, SALT LAKE CITY, UT 84124-1377
(801) 263-1621
(801) 263-1647
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
73799221205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10281976
OWNERS DOB
UT
Enumeration date
01/26/2010
Last updated
01/26/2010
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