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DANIEL JAMES CLARK DO

>> Organized Health Care Education/Training Program >> Student

Registrant NPI Number: 1003017229

Individual Registrant:
 DANIEL JAMES CLARK DO
Gender: M
Not Sole Proprietor

Location and contact information for practice:
5330 S HIGHWAY 95  FORT MOHAVE, AZ 86426-9225 US
Tel: 928-788-7115  Fax: 770-874-5483

Contact information for business:
5665 NEW NORTHSIDE DR SUITE 320 ATLANTA, GA 30328-5831 US
Tel: 770-874-5400  Fax: 770-874-5483

Registration Information:
NPI: 1003017229
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N390200000XStudent
Organized Health Care Education/Training Program
AR
Y207L00000XAllopathic & Osteopathic Physicians
Anesthesiology
OK4708
N207L00000XAllopathic & Osteopathic Physicians
Anesthesiology
ARE-5858
N207L00000XAllopathic & Osteopathic Physicians
Anesthesiology
CA20A10260
N207L00000XAllopathic & Osteopathic Physicians
Anesthesiology
WAOP 60011959
N207L00000XAllopathic & Osteopathic Physicians
Anesthesiology
AZ4799

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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