Provider Demographics
NPI:1932284478
Name:CLARK, ERIC NORBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:NORBERG
Last Name:CLARK
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 1:6 WILLARD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4694
Mailing Address - Country:US
Mailing Address - Phone:888-988-2800
Mailing Address - Fax:626-405-6768
Practice Address - Street 1:6 WILLARD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4694
Practice Address - Country:US
Practice Address - Phone:888-988-2800
Practice Address - Fax:626-405-6768
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77089174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG77089OtherSTATE LICENSE #