Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 032102 | GA |
N | 207X00000X | Orthopaedic Surgeon | 21142 | TN |
NPI | 1023002466 |
---|---|
Provider Name | Eric Peter Clarke |
First Address | Chattanooga, TN 37422 |
Second Address | Chattanooga, TN 37406-3402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 05/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00932159A | (05) | GA |
3868282 | (05) | TN |
E85005 | (02) |