Clark, Clancy J
Clark, Clancy J is an individual health care provider with primary practice located at Medical Center Blvd , Winston Salem NC 27157-0001. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Surgical Oncology. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Clark, Clancy J can be contacted via phone (336) 716-9272.Contact Information
Primary practice address
Medical Center Blvd
Winston Salem NC 27157-0001
Phone: (336) 716-9272
Fax: (336) 716-6637
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 2012-01216 | North Carolina |
| Allopathic & Osteopathic Physicians / Surgical Oncology | 2086X0206X | 2012-01216 | North Carolina |
Profile Details
| NPI number | 1053455444 |
|---|---|
| LBN Legal business name | Clark, Clancy J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 18th, 2007 |
| Last updated | Oct 1st, 2012 - about 12 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053455444 | NPPES |
| North Carolina | MEDICAID | 5920754 |
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