Provider Demographics
NPI:1891722583
Name:CLARKE, HENRY BUSHNELL (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:BUSHNELL
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:603 7TH ST S
Practice Address - Street 2:SUITE 540
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4734
Practice Address - Country:US
Practice Address - Phone:727-553-7550
Practice Address - Fax:727-553-7549
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059894207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054928200Medicaid
FLP00647724OtherRAILROAD MEDICARE PROVIDER NUMBER
FL054928200Medicaid
E89691Medicare UPIN