Clark, David W

Clark, David W is an individual health care provider with primary practice located at 11104 Parkview Circle Dr Suite 310, Fort Wayne IN 46845-1672. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Clark, David W can be contacted via phone (260) 266-5230.

Contact Information

Primary practice address
11104 Parkview Circle Dr Suite 310 Fort Wayne IN 46845-1672
Phone: (260) 266-5230
Fax: (260) 266-5238
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 01037790 Indiana

Profile Details

NPI number 1679522924
LBN Legal business name Clark, David W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 6th, 2006
Last updated Oct 10th, 2013 - about 11 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 1679522924 NPPES
Indiana MEDICAID 200015230
Indiana Other 000000672225

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