Elizabeth A Clark, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME66298 Issued in FL

Practice address

4400 E Highway 20
Ste 410
Niceville, FL 32578-8779

Phone

(850) 654-3376

Fax

(850) 654-3320

NPI assigned

Dec 13, 2005

Last updated

Jan 15, 2013By the provider in NPPES

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coastal Skin Surgery and Dermatology, PL

  • MOHS-Micrographic Surgery Physician
  • Miramar Beach, FL
  • NPI 1114238193

  Dermatology

  Medicare reassignment NPD
• Gregory Winfield Turner Sr MD PA

  • Internal Medicine Physician
  • Niceville, FL
  • NPI 1699927848
  NPD (past)

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358208000000",
    "number": "1427033463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12469 EMERALD COAST PKWY W",
            "address_2": "STE 101",
            "city": "MIRAMAR BEACH",
            "state": "FL",
            "postal_code": "325508305",
            "telephone_number": "850-654-3376",
            "fax_number": "850-654-3320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 E HIGHWAY 20",
            "address_2": "STE 410",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788779",
            "telephone_number": "850-654-3376",
            "fax_number": "850-654-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-13",
        "last_updated": "2013-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME66298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252552600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Robin Christian, LCSW
• Christina Schaefer Lactation & Family Wellness
• Zoe Christofaro
• Angela Willis Cinal, RN
• Landyn Lynn Clark Yudez
• Steven Lester Clark, MD
• Christopher Craig Clevenger, PHARMD
• Coastal Anesthesia, P a
• Coastal Orthopedic
• Coastal Vascular and Interventional PLLC

• Dermatology Physician in Niceville, FL
• Providers in Niceville, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.