Provider Demographics
NPI:1528211638
Name:JULIE CLARK, M.D., INC
Entity Type:Organization
Organization Name:JULIE CLARK, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-823-4695
Mailing Address - Street 1:1550 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6655
Mailing Address - Country:US
Mailing Address - Phone:707-792-2229
Mailing Address - Fax:707-729-1072
Practice Address - Street 1:1550 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6655
Practice Address - Country:US
Practice Address - Phone:707-792-2229
Practice Address - Fax:707-729-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98041207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty