Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G16658 | CA |
Y | 208600000X | Surgeon | G16658 | CA |
NPI | 1023072931 |
---|---|
Provider Name | Dr. Orlo H. Clark |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 22/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0G1665800 | (05) | CA |
A89257 | (02) | CA |