Provider Demographics
NPI:1427222843
Name:CLARK, CRAIG ALAN (MS, RD)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ALAN
Last Name:CLARK
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1624
Mailing Address - Country:US
Mailing Address - Phone:305-575-7000
Mailing Address - Fax:
Practice Address - Street 1:9301 SW 92ND AVE
Practice Address - Street 2:APT. #A312
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2142
Practice Address - Country:US
Practice Address - Phone:305-726-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered