Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 12715 | AL |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 12715 | AL |
NPI | 1295704419 |
---|---|
Provider Name | Mr. Joseph W Clark |
First Address | Huntsville, AL 35801 |
Second Address | Huntsville, AL 35801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 17/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000008833 | (05) | AL |
0910281 | UNITED HEALTHCARE (01) | AL |
200038944 | RAILROAD MEDICARE (01) | AL |
4233898 | AETNA (01) | AL |
51008833 | BCBS (01) | AL |
C73168 | (02) |