Provider Demographics
NPI:1942482369
Name:CLARK, LOWELL ERSKINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:ERSKINE
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 1:4225 SE CENTERBOARD LN
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6165
Mailing Address - Country:US
Mailing Address - Phone:772-288-1100
Mailing Address - Fax:772-288-1100
Practice Address - Street 1:4225 SE CENTERBOARD LN
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6165
Practice Address - Country:US
Practice Address - Phone:772-288-1100
Practice Address - Fax:772-288-1100
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12544207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51625Medicare UPIN