| Doctor Name: | STEVEN JON CLARK |
| NPI Number: | 1114952462 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | E4336 |
| Business Practice Address: | 911 Oak Park Blvd Ste 106 Pismo Beach, CA - 934493406 |
| Business Phone Number: | 8054819100 |
| Business Fax Number: | 8054819199 |
| Mailing Address: | 911 Oak Park Blvd, Ste 106 PISMO BEACH |
| State: | CA |
| Postal Code: | 934493406 |
| Phone Number: | 8054819100 |
| Fax Number: | 8054819199 |
| NPI Enumeration Date: | 07/12/2006 |
| NPI Last Update Date: | 03/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | E4336 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |