Clark, Gordon Blake

Clark, Gordon Blake is an sole proprietor health care provider with primary practice located at 21624 Midland Dr , Shawnee KS 66218-9064. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Obesity Medicine. Allopathic & Osteopathic Physicians / Obesity Medicine is his primary health care specialty. Clark, Gordon Blake can be contacted via phone (913) 643-0075.

Contact Information

Primary practice address
21624 Midland Dr Shawnee KS 66218-9064
Phone: (913) 643-0075
Fax: (913) 643-0077
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X KS 04-23518 Kansas
Allopathic & Osteopathic Physicians / Obesity Medicine 207VB0002X 04-23518 Kansas

Profile Details

NPI number 1417937145
LBN Legal business name Clark, Gordon Blake
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 19th, 2006
Last updated Nov 2nd, 2011 - about 15 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 1417937145 NPPES
Kansas MEDICAID 100305190D

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