Provider Demographics
NPI:1982802807
Name:CLARKSON, ERIC RYAN (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:RYAN
Last Name:CLARKSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-3127
Mailing Address - Country:US
Mailing Address - Phone:620-450-6201
Mailing Address - Fax:
Practice Address - Street 1:203 WATSON ST STE 200
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3092
Practice Address - Country:US
Practice Address - Phone:620-672-7422
Practice Address - Fax:620-450-1601
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-33348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS05-33348OtherSTATE LICENSE