Provider Demographics
NPI:1962455725
Name:CLARK, WILLIAM CHARLES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:CLARK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 S WHEELING AVE STE 1110
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5651
Mailing Address - Country:US
Mailing Address - Phone:918-301-6018
Mailing Address - Fax:918-770-0085
Practice Address - Street 1:2000 S WHEELING AVE STE 1110
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5651
Practice Address - Country:US
Practice Address - Phone:918-301-6018
Practice Address - Fax:918-770-0085
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24842207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200081930AMedicaid
OK243619301Medicare PIN
OKI53836Medicare UPIN