NPI 1114346434

Charles Clark, MD

Practitioner Orthopaedic Surgery Physician Nampa, ID

Practice location

Address: 9850 W St Lukes Dr, Nampa, ID 83687-7912
Phone: (208) 706-2663
Fax: (208) 489-4300
Mailing address: 2718 W Jetton Ave, Tampa, FL 33629-5327

Registered specialties

Orthopaedic Surgery Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207X00000X Licence M-15579 (ID)

Other Orthopaedic Surgery providers in Idaho →

Registry record

NPI: 1114346434
Entity type: Individual
Sex (as registered): Male
NPI issued: 15 Apr 2014
Record last updated: 13 Jan 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.