Provider Demographics
NPI:1528389731
Name:PERRIN C. CLARK, MD LLC
Entity Type:Organization
Organization Name:PERRIN C. CLARK, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-967-7600
Mailing Address - Street 1:350 CYPRESS BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-2773
Mailing Address - Country:US
Mailing Address - Phone:251-967-7600
Mailing Address - Fax:251-967-7669
Practice Address - Street 1:350 CYPRESS BEND BLVD
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-2773
Practice Address - Country:US
Practice Address - Phone:251-967-7600
Practice Address - Fax:251-967-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD29227174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty