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Contact Information

STACEY A CLARK, MD
1447 MEDICAL PARK BLVD
#402
WELLINGTON, FL33414
 Phone: 561-790-2600
 Fax: 561-790-1535
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for STACEY A CLARK · (Female)

NPI Number 1285606574
Status Active
Credentials MD
Entity Individual
Enumeration date 02/02/2006
Last updated 03/29/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • FL License # ME0070966
  • FL Medicaid 47177100
Hospital affiliation(s) Not Available
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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