Provider Demographics
NPI:1932527579
Name:CLARK, ELIZABETH ANNE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:DEPT OF OB GYN MSC 10 5580
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-4051
Mailing Address - Fax:505-272-6385
Practice Address - Street 1:DEPT OF OB GYN MSC 10 5580
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-4051
Practice Address - Fax:505-272-6385
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM390200000X
GA079783207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program