Clark, Lisa Bardy
Clark, Lisa Bardy is an sole proprietor health care provider with primary practice located at 12815 Highway 98 West Suite 116, Destin FL 32550. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Clark, Lisa Bardy can be contacted via phone (850) 269-0111.Contact Information
Primary practice address
12815 Highway 98 West Suite 116
Destin FL 32550
Phone: (850) 269-0111
Fax: (850) 269-0114
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ME73997 | Florida |
Profile Details
| NPI number | 1598779100 |
|---|---|
| LBN Legal business name | Clark, Lisa Bardy |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 28th, 2006 |
| Last updated | Jul 8th, 2007 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598779100 | NPPES |
| Other | 7589056 | AETNA USHC # | |
| Other | 43826 | AETNA USHC # |
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