Edgar T Clark
Nuclear Medicine Specialist
77 W Forest Ave Suite 101
Flagstaff
, Arizona 86001-1479
Edgar T Clark
Nuclear Medicine Specialist
77 W Forest Ave Suite 101
Flagstaff
, Arizona 86001-1479
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About
Features
Specialties
- Nuclear Medicine Specialist
Languages spoken
- English
Location
First Address
- Edgar T Clark
- Dept 2018 Po Box 29675
- Phoenix, AZ
- Zip : 85038-9675
- Phone :
Second Address
- Edgar T Clark
- 77 W Forest Ave Suite 101
- Flagstaff, AZ
- Zip : 86001-1479
- Fax : (928) 773-2240
- Phone : (928) 773-2515
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In what state does Edgar T Clark practice in?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207U00000X | Nuclear Medicine Specialist | 7408 | AZ |
National Provider Identifier
| NPI | 1295780401 |
|---|---|
| Provider Name | Edgar T Clark |
| First Address | Phoenix, AZ 85038-9675 |
| Second Address | Flagstaff, AZ 86001-1479 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/05/2006 |
| Last Update Date | 09/05/2008 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 053783 | (05) | CA |
| 053783 | (05) | IA |
| 235813 | (05) | AZ |
| 8602594002/Z1339 | (05) | UT |
| B8407 | (05) | NM |
| D36678 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.