Provider Demographics
NPI:1477655884
Name:WILLIAMS, CLARK EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:EDWARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3741 SUNSET LANE
Mailing Address - Street 2:DR CLARK E WILLIAMS FAMILY AND URGENT CARE PRACTICE
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509
Mailing Address - Country:US
Mailing Address - Phone:925-778-2999
Mailing Address - Fax:925-778-4062
Practice Address - Street 1:3741 SUNSET LANE
Practice Address - Street 2:DR CLARK E WILLIAMS FAMILY AND URGENT CARE PRACTICE
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509
Practice Address - Country:US
Practice Address - Phone:925-778-2999
Practice Address - Fax:925-753-1397
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08868Medicare UPIN
020A50190Medicare ID - Type Unspecified