Provider Demographics
NPI:1598779118
Name:CLARK, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 8TH ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1623
Mailing Address - Country:US
Mailing Address - Phone:504-833-7770
Mailing Address - Fax:504-833-7782
Practice Address - Street 1:3223 8TH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1623
Practice Address - Country:US
Practice Address - Phone:504-833-7770
Practice Address - Fax:504-833-7782
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024901207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1420417Medicaid
LAH50836Medicare UPIN
LA1420417Medicaid