Provider Demographics
NPI:1073556379
Name:CLARKE, PATRICIA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LOUISE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:STANDTAL
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, DMIN
Mailing Address - Street 1:14435 N 7TH ST STE 300B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4385
Mailing Address - Country:US
Mailing Address - Phone:928-774-3373
Mailing Address - Fax:928-213-9206
Practice Address - Street 1:14435 N 7TH ST STE 300B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4385
Practice Address - Country:US
Practice Address - Phone:928-774-3373
Practice Address - Fax:928-213-9206
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03D0993675OtherCLIA
AZ26877OtherMEDICAL LICENSE
AZ1154508273OtherSHEDOC NPI
AZ559239Medicaid
AZZ66408OtherPTAN
AZ1073556379OtherCLARKE'S NPI
AZZ66408OtherPTAN
AZ26877OtherMEDICAL LICENSE
AZ86-1016172OtherEIN