Provider Demographics
NPI:1417906181
Name:SHEFFIELD, CLARK WHITELEY (MD)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:WHITELEY
Last Name:SHEFFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3550 N UNIVERSITY AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6685
Mailing Address - Country:US
Mailing Address - Phone:801-374-9625
Mailing Address - Fax:801-373-7506
Practice Address - Street 1:1159 E 200 N
Practice Address - Street 2:STE. 350
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2022
Practice Address - Country:US
Practice Address - Phone:801-756-4781
Practice Address - Fax:801-756-5091
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT353117-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT49415OtherPEHP INS.
UT346272OtherDMBA INS.
UT766OtherU OF U HEALTHPLANS
UT107008084102OtherSELECT HEALTH PLAN
UTQM0000026679OtherALTIUS
UT107008084102OtherSELECT HEALTH PLAN
UTQM0000026679OtherALTIUS
UT000012059Medicare PIN