Provider Demographics
NPI:1215564190
Name:SANTEE, CLARK (MD)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:
Last Name:SANTEE
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 1:240 SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1323
Mailing Address - Country:US
Mailing Address - Phone:415-552-3870
Mailing Address - Fax:
Practice Address - Street 1:165 CAPP ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1209
Practice Address - Country:US
Practice Address - Phone:415-510-8282
Practice Address - Fax:415-552-3998
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA187946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine