Individual
DR. CLARENCE E. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
485 S DOBSON RD STE 201, CHANDLER, AZ 85224-5604
(480) 728-4700
(480) 728-4747
Mailing address
PO BOX 33269, PHOENIX, AZ 85067-3269
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
61606
AZ
208C00000X
Colon & Rectal Surgery Physician
Primary
61606
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003126879A
—
GA
05
—
003126879C
—
GA
Enumeration date
11/14/2007
Last updated
12/16/2024
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