Provider Demographics
NPI:1003083700
Name:CLARK, WILLIAM W (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:CLARK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:975 ROBERTA LN
Mailing Address - Street 2:STE 101B
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6805
Mailing Address - Country:US
Mailing Address - Phone:775-870-1545
Mailing Address - Fax:775-686-6327
Practice Address - Street 1:975 ROBERTA LN STE 101B
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6805
Practice Address - Country:US
Practice Address - Phone:775-870-1545
Practice Address - Fax:844-965-9017
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1419207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPENDINGMedicaid
NVPENDINGMedicaid