Douglas Wayne Clink, M.D.
Individual provider Active NPI Surgery Physician · Boaz, AL
NPI 1376694596 · NPPES record last updated Feb 15, 2012
Key facts
- NPI
- 1376694596
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 10842 (AL)
- Practice address
- 2525 US Highway 431
Suite 170
Boaz, AL 35957-5934 - Phone
- (256) 593-1611
- Fax
- (256) 840-4596
- NPI assigned
- Jan 15, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marshall Surgical Clinic, PC | Surgery | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 10842 | AL | Yes |
Addresses
Primary practice location
2525 US Highway 431
Suite 170
Boaz, AL 35957-5934
Mailing address
2525 US Highway 431
Suite 170
Boaz, AL 35957-5934
Phone (256) 593-1611
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000011747 | Medicaid | AL | |
| 51011747 | Other | AL | BLUE CROSS BLUE SHIELD |
Other providers in Boaz, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2012. 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.