Clark, Gordon H

Clark, Gordon H is an individual health care provider with primary practice located at 2314 S Range Ave , Denham Springs LA 70726-5216. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Clark, Gordon H can be contacted via phone (225) 480-4080.

Contact Information

Primary practice address
2314 S Range Ave Denham Springs LA 70726-5216
Phone: (225) 480-4080
Fax: (877) 485-4275
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 19473 Mississippi
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X DR.0059785 Colorado
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD 203009 Louisiana

Profile Details

NPI number 1265546014
LBN Legal business name Clark, Gordon H
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 18th, 2006
Last updated Nov 24th, 2021 - about 5 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 1265546014 NPPES
Louisiana MEDICAID 1066656

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