Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 223227 | NY |
N | 207X00000X | Orthopaedic Surgeon | 35934 | AZ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35934 | AZ |
NPI | 1164434734 |
---|---|
Provider Name | Alexander M Clark JR. |
First Address | Potsdam, NY 13676-1889 |
Second Address | Potsdam, NY 13676-1889 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 14/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124517 | (05) | AZ |
I38261 | (02) | AZ |