Clark Family Medicine

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

ME0073997 Issued in FL

Legal business name

CLARK FAMILY MEDICINE

Practice address

12815 US Highway 98 W Ste 116
Miramar Beach, FL 32550-3245

Phone

(850) 269-0111

Fax

(850) 269-0114

NPI assigned

Nov 17, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Lisa Bardy Clark, M.D.

Title

Owner

Phone

(850) 269-0111

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447718400000",
    "number": "1194199919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12815 US HIGHWAY 98 W STE 116",
            "city": "MIRAMAR BEACH",
            "state": "FL",
            "postal_code": "325503245",
            "telephone_number": "850-269-0111",
            "fax_number": "850-269-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12815 US HIGHWAY 98 W STE 116",
            "city": "MIRAMAR BEACH",
            "state": "FL",
            "postal_code": "325503245",
            "telephone_number": "850-269-0111",
            "fax_number": "850-269-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-17",
        "last_updated": "2015-11-17",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "BARDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-269-0111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME0073997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Miramar Beach, FL
• Providers in Miramar Beach, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; 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.