Doctor Name: | DR. GEORGE WESLEY CLARK |
NPI Number: | 1285900746 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | G32610 |
Business Practice Address: | 2049 Snapdragon Ln Alpine, CA - 919011304 |
Business Phone Number: | 6197226952 |
Business Fax Number: | 6197226952 |
Mailing Address: | 2049 Snapdragon Ln, ALPINE |
State: | CA |
Postal Code: | 919011304 |
Phone Number: | 6197226952 |
Fax Number: | 6197226952 |
NPI Enumeration Date: | 03/29/2012 |
NPI Last Update Date: | 03/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G32610 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |