Provider Demographics
NPI:1225273436
Name:CLARKE, PATRICIA HALL (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:HALL
Last Name:CLARKE
Suffix:
Gender:F
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 1870
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95077-1870
Mailing Address - Country:US
Mailing Address - Phone:831-728-0222
Mailing Address - Fax:831-707-2777
Practice Address - Street 1:45 NEILSON ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2468
Practice Address - Country:US
Practice Address - Phone:831-728-0222
Practice Address - Fax:831-707-2777
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics