Provider Demographics
NPI:1770666729
Name:CLARK, CLIFFORD P III (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:P
Last Name:CLARK
Suffix:III
Gender:M
Credentials:MD, PA
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Mailing Address - Street 1:701 W MORSE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3731
Mailing Address - Country:US
Mailing Address - Phone:407-629-5555
Mailing Address - Fax:407-629-4884
Practice Address - Street 1:701 W MORSE BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3731
Practice Address - Country:US
Practice Address - Phone:407-629-5555
Practice Address - Fax:407-629-4884
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0065670208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery