Provider Demographics
NPI:1255626701
Name:CLARK, GUNNAR C (MD)
Entity type:Individual
Prefix:DR
First Name:GUNNAR
Middle Name:C
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:PO BOX 29211
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9211
Mailing Address - Country:US
Mailing Address - Phone:480-374-7308
Mailing Address - Fax:602-267-8919
Practice Address - Street 1:604 W WARNER RD STE A
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2900
Practice Address - Country:US
Practice Address - Phone:602-309-4709
Practice Address - Fax:602-419-2951
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53950207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology