Clark, G Gregory

Clark, G Gregory is an individual health care provider with primary practice located at 9002 N Meridian St Suite 112, Indianapolis IN 46260-5381. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Clark, G Gregory can be contacted via phone (317) 843-9005.

Contact Information

Primary practice address
9002 N Meridian St Suite 112 Indianapolis IN 46260-5381
Phone: (317) 843-9005
Fax: (317) 580-0443
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 0132124A Indiana

Profile Details

NPI number 1679642912
LBN Legal business name Clark, G Gregory
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 8th, 2006
Last updated Jan 5th, 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 1679642912 NPPES
Indiana MEDICAID 100326120
Indiana Other 000000538215

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