Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | M5840 | ID |
NPI | 1174572697 |
---|---|
Provider Name | Dr. Mark Campion Clawson |
First Address | Boise, ID 83706-1338 |
Second Address | Boise, ID 83706-1338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 24/08/2015 |