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NPI Lookup from the NPI Registry — National Provider Identifier Database

Contact Information

DANIEL J CLARK, DO
5330 S HIGHWAY 95
FORT MOHAVE, AZ86426-9225
 Phone: 928-788-7115
 Fax: 770-874-5483
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for DANIEL J CLARK · (Male)

NPI # 1003017229
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 05/29/2007
Last updated 12/05/2013 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • AR License # E-5858
  • AZ License # 4799
  • CA License # 20A10260
  • OK License # 4708
  • WA License # OP 60011959
Hospital affiliation(s)
  • THE QUEENS MEDICAL CENTER - (Acute Care)
    1301 PUNCHBOWL ST
    HONOLULU, HI 96813
  • WILCOX MEMORIAL HOSPITAL - (Acute Care)
    3-3420 KUHIO HIGHWAY
    LIHUE, HI 96766
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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