John Louis Clark, MD

Primary specialty

Surgical Oncology PhysicianTaxonomy code 2086X0206X

License

35619 Issued in MN

Practice address

1Veterans Drive, Surgical Service/112
Minneapolis, MN 55417

Phone

(612) 725-2065

Fax

(612) 725-2227

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: john.clark.1@15839.direct.athenahealth.com

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174618623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1VETERANS DRIVE, SURGICAL SERVICE/112",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55417",
            "telephone_number": "612-725-2065",
            "fax_number": "612-725-2227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1VETERANS DRIVE, SURGICAL SERVICE/112",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55417",
            "telephone_number": "612-725-2065",
            "fax_number": "612-725-2227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOHN",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "MN",
            "license": "35619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hailey Mae Clark, RN, BSN, CHPN, PHN
• Holly Diane Clark, LICSW
• Howard Brent Clark, M.D.
• Jennifer Clark
• Jennifer Anna Clark, RD, LD
• Mary Watson Clark, LICSW, LMSW
• Megan Elizabeth Clark, RN
• Mekka Clark
• Monique Clark, RPH
• Nicholas Clark

• Surgical Oncology Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Surgical Oncology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.