| Gary W Clark Dpm A Professional Corp | |
|
166 W 1325 N, Suite 300, Cedar City, UT 84720-7792 | |
| (435) 867-8521 | |
| Not Available |
| Full Name | Gary W Clark Dpm A Professional Corp |
|---|---|
| Type | Facility |
| Speciality | Podiatrist |
| Location | 166 W 1325 N, Cedar City, Utah |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629140173 | NPI | - | NPPES |
| 529212733004 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213E00000X | Podiatrist | 320729-0501 (Utah) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | 3207290501 (Utah) | Secondary |
| Provider Name | Gary W Clark |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1609861152 PECOS PAC ID: 9335247618 Enrollment ID: I20070611000270 |
| Mailing Address | Practice Location Address |
|---|---|
| Gary W Clark Dpm A Professional Corp Po Box 1986, Cedar City, UT 84721-1986 Ph: (435) 867-8521 | Gary W Clark Dpm A Professional Corp 166 W 1325 N, Suite 300, Cedar City, UT 84720-7792 Ph: (435) 867-8521 |
Advanced Foot & Ankle Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 1811 W Royal Hunte Dr, Suite 2, Cedar City, UT 84720 Phone: 435-586-2225 Fax: 435-867-1909 | |
Dr. Brad Scott Webb, D.P.M. Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1811 W Royal Hunte Dr Ste 2, Cedar City, UT 84720 Phone: 435-586-2225 Fax: 435-867-1909 | |
Dr. Gary W Clark, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 166 W 1325 N, Suite 300, Cedar City, UT 84721 Phone: 435-867-8521 Fax: 435-586-4073 | |
Dr. Russell G Olsen, DPM Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 1811 W Royal Hunte Dr, Suite 2, Cedar City, UT 84720 Phone: 435-586-2225 Fax: 435-867-1909 | |
Meta Foot And Ankle Pc Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 1811 W Royal Hunte Dr, Suite 2, Cedar City, UT 84720 Phone: 435-586-2225 Fax: 435-867-1909 |