Clark, Chad Leroy

Clark, Chad Leroy is an individual health care provider with primary practice located at 3865 Jackson St , Riverside CA 92503-3919. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Clark, Chad Leroy can be contacted via phone (951) 352-5666.

Contact Information

Primary practice address
3865 Jackson St Riverside CA 92503-3919
Phone: (951) 352-5666
Fax: (951) 352-5445
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X A70662 California

Profile Details

NPI number 1023052545
LBN Legal business name Clark, Chad Leroy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2006
Last updated Jun 13th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023052545 NPPES
California MEDICAID 00A706620

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