Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 9700217 | NC |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 9700217 | NC |
NPI | 1053308288 |
---|---|
Provider Name | Joseph M Clark |
First Address | Winston Salem, NC 27114-4848 |
Second Address | Burlington, NC 27215-8700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 30/04/2021 |