Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 23063 | IA |
N | 207Q00000X | Family Doctor | 23063 | IL |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 23063 | IA |
NPI | 1083639140 |
---|---|
Provider Name | William D Clark |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 29/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D90036 | (02) | IA |