Provider Demographics
NPI:1912016056
Name:CLARKE, PAUL W (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:W
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1319 N MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1721
Mailing Address - Country:US
Mailing Address - Phone:573-335-5100
Mailing Address - Fax:573-335-0339
Practice Address - Street 1:1319 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1721
Practice Address - Country:US
Practice Address - Phone:573-335-5100
Practice Address - Fax:573-335-0339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR7634207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200255701Medicaid
MO200255701Medicaid
MOA11944Medicare UPIN