Gaddy, Clark Dale
Gaddy, Clark Dale is an individual health care provider with primary practice located at 1179 Nw 64Th Ter , Gainesville FL 32605-4218. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Gaddy, Clark Dale can be contacted via phone (352) 333-5400.Contact Information
Primary practice address
1179 Nw 64Th Ter
Gainesville FL 32605-4218
Phone: (352) 333-5400
Fax: (352) 333-5404
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | ME0048155 | Florida |
Profile Details
| NPI number | 1528092061 |
|---|---|
| LBN Legal business name | Gaddy, Clark Dale |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 10th, 2006 |
| Last updated | Dec 9th, 2009 - about 15 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 | 1528092061 | NPPES |
| Florida | MEDICAID | 043860000 |
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