Provider Demographics
NPI:1376592782
Name:CLAPP, MARK ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:CLAPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:315 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2603
Mailing Address - Country:US
Mailing Address - Phone:931-526-1050
Mailing Address - Fax:931-526-8163
Practice Address - Street 1:315 N WASHINGTON AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2603
Practice Address - Country:US
Practice Address - Phone:931-526-1050
Practice Address - Fax:931-526-8163
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYC0365207P00000X
TN18488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3030409Medicaid
TNA99431Medicare UPIN
TN3030409Medicaid