Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 20A10260 | CA |
Y | 207L00000X | Anesthesiologist | 4708 | OK |
N | 207L00000X | Anesthesiologist | 4799 | AZ |
N | 207L00000X | Anesthesiologist | E-5858 | AR |
N | 207L00000X | Anesthesiologist | OP 60011959 | WA |
NPI | 1003017229 |
---|---|
Provider Name | Daniel James Clark |
First Address | Atlanta, GA 30328-5831 |
Second Address | Fort Mohave, AZ 86426-9225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 05/12/2013 |