John B Clark JR.
Emergency Physician
1900 Randolph Rd Ste 900
Charlotte
, North Carolina 28207-1106
John B Clark JR.
Emergency Physician
1900 Randolph Rd Ste 900
Charlotte
, North Carolina 28207-1106
(704) 377-2687
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About
Features
Specialties
- Emergency Physician
Languages spoken
- English
Location
First Address
- John B Clark JR.
- 1900 Randolph Rd Ste 900
- Charlotte, NC
- Zip : 28207-1106
- Fax : (704) 377-2687
- Phone : (704) 377-2424
Second Address
- John B Clark JR.
- 1900 Randolph Rd Ste 900
- Charlotte, NC
- Zip : 28207-1106
- Fax : (704) 377-2687
- Phone : (704) 377-2424
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207P00000X | Emergency Physician | 23260 | NC |
National Provider Identifier
| NPI | 1003866443 |
|---|---|
| Provider Name | John B Clark JR. |
| First Address | Charlotte, NC 28207-1106 |
| Second Address | Charlotte, NC 28207-1106 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/05/2006 |
| Last Update Date | 24/10/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 22664 | BCBSNC (01) | NC |
| 89-22664 | (05) | NC |
| 930067545 | RR MEDICARE (01) | NC |
| C83241 | (02) | |
| N23260 | (05) | SC |
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.