Provider Demographics
NPI:1023002466
Name:CLARKE, ERIC PETER (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:PETER
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23446
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422
Mailing Address - Country:US
Mailing Address - Phone:423-624-8588
Mailing Address - Fax:423-622-3069
Practice Address - Street 1:2707 CITICO AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-3402
Practice Address - Country:US
Practice Address - Phone:423-624-8588
Practice Address - Fax:423-622-3069
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21142207X00000X
GA032102207X00000X
AL29432174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3868282Medicaid
GA00932159AMedicaid
E85005Medicare UPIN
20BBFJVMedicare ID - Type Unspecified
TN3868282Medicare ID - Type Unspecified