Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD.37170 | AL |
N | 111NI0900X | Internist | MD.37170 | AL |
N | 2080P0202X | Pediatric Cardiologist | MD.37170 | AL |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD.37170 | AL |
NPI | 1154618106 |
---|---|
Provider Name | Matthew Gill Clark |
First Address | Birmingham, AL 35233-1711 |
Second Address | Birmingham, AL 35233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 07/10/2020 |