Clark, William Bruce

Clark, William Bruce is an individual health care provider with primary practice located at 585 Lew Loudon Road , Latham NY 12110-5701. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Clark, William Bruce can be contacted via phone (518) 783-1472.

Contact Information

Primary practice address
585 Lew Loudon Road Latham NY 12110-5701
Phone: (518) 783-1472
Fax: (518) 783-1605
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 114221 New York

Profile Details

NPI number 1235202599
LBN Legal business name Clark, William Bruce
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 16th, 2006
Last updated Oct 3rd, 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235202599 NPPES
New York MEDICAID 00798590

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