Clark, James W

Clark, James W is an individual health care provider with primary practice located at 1885 Plaza Dr , Eagan MN 55122-2612. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Clark, James W can be contacted via phone (952) 993-4001.

Contact Information

Primary practice address
1885 Plaza Dr Eagan MN 55122-2612
Phone: (952) 993-4001
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 26114 Minnesota

Profile Details

NPI number 1306824255
LBN Legal business name Clark, James W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 1st, 2006
Last updated Mar 1st, 2012 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306824255 NPPES
Minnesota MEDICAID 444703400

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