Provider Demographics
NPI:1902840812
Name:CLYDE, MARK ELIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELIOT
Last Name:CLYDE
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 1:2490 S. WOODWORTH LOOP
Mailing Address - Street 2:STE 350
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7411
Mailing Address - Country:US
Mailing Address - Phone:907-745-2663
Mailing Address - Fax:907-745-2600
Practice Address - Street 1:2490 S. WOODWORTH LOOP
Practice Address - Street 2:STE 350
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7411
Practice Address - Country:US
Practice Address - Phone:907-745-2663
Practice Address - Fax:907-745-2600
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4734207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00111691OtherMDCR RAILROAD
AKMD1984Medicaid
AKMD1984Medicaid
AKK151848Medicare PIN