Bradley Clark, M.D.
Individual provider Active NPI Emergency Medicine Physician · Inkom, ID
NPI 1124354964 · NPPES record last updated Oct 29, 2009
Key facts
- NPI
- 1124354964
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- M-8299 (ID)
- Practice address
- 423 E Elaine Cir
Inkom, ID 83245-1716 - Phone
- (208) 251-9482
- NPI assigned
- Oct 29, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-8299 | ID | MD | Emergency Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | M-8299 | ID | Yes |
Addresses
Primary practice location
423 E Elaine Cir
Inkom, ID 83245-1716
Mailing address
423 E Elaine Cir
Inkom, ID 83245-1716
Phone (208) 251-9482
Other providers in Inkom, ID
- Andrea Campbell
- Existence Services, LLC
- Lacey Garfield
- Martin Landon Ladwig
- Terrylynn Leissring
- Darlene M Stephenson
All providers in Inkom, ID · Emergency Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.