Provider Demographics
NPI:1407169048
Name:CRAIG D. CLARK, M.D., PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:CRAIG D. CLARK, M.D., PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-528-7057
Mailing Address - Street 1:PO BOX 530278
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0278
Mailing Address - Country:US
Mailing Address - Phone:702-982-1300
Mailing Address - Fax:702-898-8767
Practice Address - Street 1:2405 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2717
Practice Address - Country:US
Practice Address - Phone:702-982-1300
Practice Address - Fax:702-898-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-25
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty