Provider Demographics
NPI:1437190576
Name:CLARK, THOMAS J (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:CLARK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:121 GRAY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1800
Mailing Address - Country:US
Mailing Address - Phone:888-282-7472
Mailing Address - Fax:805-563-5410
Practice Address - Street 1:2403 CASTILLO ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5316
Practice Address - Country:US
Practice Address - Phone:805-823-6688
Practice Address - Fax:805-617-1743
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A86212084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF79595Medicare UPIN
F79595Medicare UPIN
CA020A86211Medicare PIN