Provider Demographics
NPI:1225026743
Name:DREILINGER, CLARK L (MD)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:L
Last Name:DREILINGER
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:PO BOX 824406
Mailing Address - Street 2:
Mailing Address - City:SOUTH FLORIDA
Mailing Address - State:FL
Mailing Address - Zip Code:33082-4406
Mailing Address - Country:US
Mailing Address - Phone:954-423-6836
Mailing Address - Fax:
Practice Address - Street 1:1111 SE FEDERAL HWY
Practice Address - Street 2:SUITE 230
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3840
Practice Address - Country:US
Practice Address - Phone:772-221-4088
Practice Address - Fax:772-221-4089
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME178622084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250213500Medicaid
FL93222YMedicare ID - Type Unspecified
FL250213500Medicaid