Provider Demographics
NPI:1811158884
Name:CLARKE, JOSEPH CAPT (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CAPT
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6101
Mailing Address - Country:US
Mailing Address - Phone:541-779-7331
Mailing Address - Fax:541-779-3522
Practice Address - Street 1:1170 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6101
Practice Address - Country:US
Practice Address - Phone:541-779-7331
Practice Address - Fax:541-779-3552
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD171170207Y00000X
IAR-8429207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500-683051Medicaid