Clancy J Clark
Surgeon Surgical Oncologist
Medical Center Blvd
Winston Salem
, North Carolina 27157-0001
Clancy J Clark
Surgeon Surgical Oncologist
Medical Center Blvd
Winston Salem
, North Carolina 27157-0001
(336) 716-6637
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About
Features
Specialties
- Surgeon
- Surgical Oncologist
Languages spoken
- English
Location
First Address
- Clancy J Clark
- Po Box 602658
- Charlotte, NC
- Zip : 28260-2658
- Fax : (336) 716-6637
- Phone : (336) 716-9272
Second Address
- Clancy J Clark
- Medical Center Blvd
- Winston Salem, NC
- Zip : 27157-0001
- Fax : (336) 716-6637
- Phone : (336) 716-9272
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208200000X | Surgeon | 2012-01216 | NC |
| Y | 208600000X | Surgeon | 2012-01216 | NC |
| N | 2086X0206X | Surgical Oncologist | 2012-01216 | NC |
National Provider Identifier
| NPI | 1053455444 |
|---|---|
| Provider Name | Clancy J Clark |
| First Address | Charlotte, NC 28260-2658 |
| Second Address | Winston Salem, NC 27157-0001 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 18/02/2007 |
| Last Update Date | 01/10/2012 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 5920754 | (05) | NC |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.