Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD038937E | PA |
NPI | 1043202930 |
---|---|
Provider Name | Dr. Francis J Clark |
First Address | Levittown, PA 19057-1500 |
Second Address | Hatboro, PA 19040-2033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 24/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007026401 | (05) | PA |
E67815 | (02) | PA |