Provider Demographics
NPI:1073600086
Name:CLAWSON, MARK EDWARD (MD PMC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:CLAWSON
Suffix:
Gender:M
Credentials:MD PMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 STATE ST
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-4739
Mailing Address - Country:US
Mailing Address - Phone:337-824-8099
Mailing Address - Fax:337-824-8229
Practice Address - Street 1:805 STATE ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-4739
Practice Address - Country:US
Practice Address - Phone:337-824-8099
Practice Address - Fax:337-824-8229
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020456207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA020456OtherSTATE LICENSE
LA1900249Medicaid
LA1900249Medicaid
LA5K781Medicare PIN