Clark, Christopher Shadburn

Clark, Christopher Shadburn is an individual health care provider with primary practice located at 777 37Th St , Vero Beach FL 32960-4873. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Clark, Christopher Shadburn can be contacted via phone (772) 778-7217.

Contact Information

Primary practice address
777 37Th St Vero Beach FL 32960-4873
Phone: (772) 778-7217
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X ME80173 Florida

Profile Details

NPI number 1184721912
LBN Legal business name Clark, Christopher Shadburn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Jul 8th, 2007 - about 17 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 1184721912 NPPES
Florida MEDICAID 261068000

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