Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 105275-0507 | UT |
N | 222Z00000X | Podiatrist | 105275-0507 | UT |
N | 2081S0010X | Sports Medicine | 105275-0507 | UT |
N | 213ES0000X | Sports Medicine | 105275-0507 | UT |
Y | 213ES0103X | Foot & Ankle Surgery | 105275-0507 | UT |
NPI | 1477649234 |
---|---|
Provider Name | Francis J Clark |
First Address | West Jordan, UT 84088-5710 |
Second Address | West Jordan, UT 84088-5711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 22/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480035147 | MEDICARE RAILROAD (01) | UT |
T77973 | (02) | UT |