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DR. VIVIENNE M CLARKE MD

>> Pediatrics >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1477791630

Individual Registrant:
DR. VIVIENNE M CLARKE MD
Gender: F
Not Sole Proprietor

Location and contact information for practice:
12196 COUNTY ROAD 512  FELLSMERE, FL 32948-5463 US
Tel: 772-257-8224  Fax: 772-213-3157

Contact information for business:
1545 9TH ST SW  VERO BEACH, FL 32962-4312 US
Tel: 772-257-8224  Fax: 772-213-3157

Registration Information:
NPI: 1477791630
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N208000000XAllopathic & Osteopathic Physicians
Pediatrics
PAMT-193978
Y208000000XAllopathic & Osteopathic Physicians
Pediatrics
FLME112465

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE LICENSEME112465FL01




HEALTH CARE JOBS FL - Page 1



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