Provider Demographics
NPI:1376810143
Name:CLARK, ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4733 W ATLANTIC AVE STE C-2
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3706
Mailing Address - Country:US
Mailing Address - Phone:561-995-0229
Mailing Address - Fax:561-288-9045
Practice Address - Street 1:140 JUPITER LAKES BLVD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7196
Practice Address - Country:US
Practice Address - Phone:561-320-9298
Practice Address - Fax:772-288-3341
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO4514213ES0103X
CA5156213ES0103X
NH0353213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery