Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 901805591205 | UT |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 180559-1205 | UT |
NPI | 1194731323 |
---|---|
Provider Name | James L Clark |
First Address | American Fork, UT 84003-3835 |
Second Address | American Fork, UT 84003-3835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 25/06/2019 |