| Doctor Name: | DR. DOUGLAS OWEN CLARK |
| NPI Number: | 1821308974 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 16533 |
| Business Practice Address: | 21010 Black Walnut Ln A Brookfield, WI - 530454062 |
| Business Phone Number: | 2627800594 |
| Business Fax Number: | |
| Mailing Address: | 2418 E Bluejay Bluff Ln, A GREEN VALLEY |
| State: | AZ |
| Postal Code: | 856145568 |
| Phone Number: | 4147916184 |
| Fax Number: | |
| NPI Enumeration Date: | 10/07/2010 |
| NPI Last Update Date: | 05/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 16533 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |