Clark, Edgar T

Clark, Edgar T is an individual health care provider with primary practice located at 77 W Forest Ave Suite 101, Flagstaff AZ 86001-1479. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Nuclear Medicine, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Clark, Edgar T can be contacted via phone (928) 773-2515.

Contact Information

Primary practice address
77 W Forest Ave Suite 101 Flagstaff AZ 86001-1479
Phone: (928) 773-2515
Fax: (928) 773-2240
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nuclear Medicine 207U00000X 7408 Arizona
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 7408 Arizona

Profile Details

NPI number 1295780401
LBN Legal business name Clark, Edgar T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2006
Last updated May 9th, 2008 - 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 1295780401 NPPES
Iowa MEDICAID 053783
Iowa MEDICAID 235813
Iowa MEDICAID 8602594002/Z1339
Iowa MEDICAID 053783
Iowa MEDICAID B8407

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