Clark, Gordon Blake
Clark, Gordon Blake is an sole proprietor health care provider with primary practice located at 21624 Midland Dr , Shawnee KS 66218-9064. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Obesity Medicine. Allopathic & Osteopathic Physicians / Obesity Medicine is his primary health care specialty. Clark, Gordon Blake can be contacted via phone (913) 643-0075.Contact Information
Primary practice address
21624 Midland Dr
Shawnee KS 66218-9064
Phone: (913) 643-0075
Fax: (913) 643-0077
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | KS 04-23518 | Kansas |
Allopathic & Osteopathic Physicians / Obesity Medicine | 207VB0002X | 04-23518 | Kansas |
Profile Details
NPI number | 1417937145 |
---|---|
LBN Legal business name | Clark, Gordon Blake |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Jan 19th, 2006 |
Last updated | Nov 2nd, 2011 - about 13 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 | 1417937145 | NPPES |
Kansas | MEDICAID | 100305190D |
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