Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | N2444 | TX |
NPI | 1194796128 |
---|---|
Provider Name | Dr. Perrin C Clark |
First Address | Ormond Beach, FL 32174-8154 |
Second Address | Ormond Beach, FL 32174-8154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 07/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
IO188Z | (02) | FL |