Provider Demographics
NPI:1215213269
Name:CLARKE, DAVID (CPED)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:CLARKE
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 UNIVERSITY DR NW STE 37-395
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-1776
Mailing Address - Country:US
Mailing Address - Phone:256-274-1674
Mailing Address - Fax:
Practice Address - Street 1:6275 UNIVERSITY DR NW STE 37-395
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-1776
Practice Address - Country:US
Practice Address - Phone:256-274-1674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALCPED3432174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist