Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 2017-02091 | NC |
NPI | 1134480668 |
---|---|
Provider Name | Dr. Christopher Jerome Clark |
First Address | Greensboro, NC 27405-3633 |
Second Address | Greensboro, NC 27405-3633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 15/03/2021 |