Clark, Douglas L

Clark, Douglas L is an individual health care provider with primary practice located at 2116 W Faidley Ave , Grand Island NE 68803-4678. He recently has only one registered license in Allopathic & Osteopathic Physicians / Radiation Oncology, which is considered as his primary health care specialty. Clark, Douglas L can be contacted via phone (308) 398-5996.

Contact Information

Primary practice address
2116 W Faidley Ave Grand Island NE 68803-4678
Phone: (308) 398-5996
Fax: (308) 398-5333
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Radiation Oncology 2085R0001X 26077 Oklahoma
Allopathic & Osteopathic Physicians / Radiation Oncology 2085R0001X 12230 North Dakota
Allopathic & Osteopathic Physicians / Radiation Oncology 2085R0001X 35899 Washington
Allopathic & Osteopathic Physicians / Radiation Oncology 2085R0001X 27361 Nebraska

Profile Details

NPI number 1801982939
LBN Legal business name Clark, Douglas L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 5th, 2006
Last updated Sep 3rd, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801982939 NPPES
Oklahoma MEDICAID 200134920A

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