Clark, Jan Dean
Clark, Jan Dean is an individual health care provider with primary practice located at 300 No Willson 602F, Bozeman MT 59715. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Clark, Jan Dean can be contacted via phone (406) 586-5318.Contact Information
Primary practice address
300 No Willson 602F
Bozeman MT 59715
Phone: (406) 586-5318
Fax: (406) 586-1635
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | 79 | Montana |
Profile Details
| NPI number | 1497803803 |
|---|---|
| LBN Legal business name | Clark, Jan Dean |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 8th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 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 | 1497803803 | NPPES |
| Montana | MEDICAID | 0390091 |
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