Provider Demographics
NPI:1821109349
Name:DAVID A. CLARK, M.D., MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DAVID A. CLARK, M.D., MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-649-9330
Mailing Address - Street 1:880 CASS ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2947
Mailing Address - Country:US
Mailing Address - Phone:831-649-9330
Mailing Address - Fax:831-649-9335
Practice Address - Street 1:880 CASS ST
Practice Address - Street 2:SUITE 108
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2947
Practice Address - Country:US
Practice Address - Phone:831-649-9330
Practice Address - Fax:831-649-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G123030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G123035OtherMEDICARE INDIV-STAN PTAN
CAGR0057973Medicaid
CA00G123034OtherMEDICARE INDIV PTAN
CAZZZ39341ZOtherMEDICARE GRP PTAN
CAZZZ04915ZOtherMEDICARE GRP-STAN PTAN
CA06E9948OtherTRICARE
CA06E9948OtherTRICARE