Individual
DR. CHRISTOPHER E CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
57 DEWEY ST, LUCEDALE, MS 39452-5707
(601) 766-0308
(601) 766-0309
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 766-0308
(601) 766-0309
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2016-00328
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05788788
—
MS
01
—
909150
MEDICARE
MS
Enumeration date
11/23/2010
Last updated
02/06/2020
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