Provider Demographics
NPI:1205198504
Name:CLARK, MEGAN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:CLARK
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Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:DC046.00
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-0001
Mailing Address - Country:US
Mailing Address - Phone:573-882-0406
Mailing Address - Fax:573-884-4540
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:DC046.00
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-0406
Practice Address - Fax:573-884-4540
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2013-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2012016478208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation