Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G1009A | CA |
NPI | 1063574788 |
---|---|
Provider Name | Guy Clark |
First Address | Santa Barbara, CA 93105-4301 |
Second Address | Santa Barbara, CA 93105-4301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G10090 | (05) | CA |
A37815 | (02) | CA |