John B Clark Jr., M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

23260 Issued in NC

Practice address

1900 Randolph Rd
Ste 900
Charlotte, NC 28207-1106

Phone

(704) 377-2424

Fax

(704) 377-2687

NPI assigned

May 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1003866443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 RANDOLPH RD",
            "address_2": "STE 900",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071106",
            "telephone_number": "704-377-2424",
            "fax_number": "704-377-2687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 RANDOLPH RD",
            "address_2": "STE 900",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071106",
            "telephone_number": "704-377-2424",
            "fax_number": "704-377-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOHN",
        "middle_name": "B",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "23260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N23260",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "22664",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "930067545",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89-22664",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Anne Clark, MD, MPH
• Elizabeth Anne Clark, LCSW
• Emily A Clark, SLP
• Herman Clark, LCAS-A
• Jason Drew Clark, D.D.S.
• Kortney Wilson Clark, FNP
• Kristie Dawn Clark, PHARMD, CDE
• Laura L Clark, MS, LCAS
• Lawrence Clark, LCMHC, LCASA, LPC
• Lisa R Clark, PT

• Emergency Medicine Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Emergency Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.