Bliss Watson Clark II, M.D.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

G59282 Issued in CA

Practice address

1262 E North St
Manteca, CA 95336-4962

Phone

(209) 214-7053

Fax

(209) 523-0764

NPI assigned

Jul 14, 2005

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Bliss W Clark MD PA

  • Specialist
  • Harlingen, TX
  • NPI 1316065089
  NPD (past)

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320451200000",
    "number": "1447258272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 FLORIDA AVE",
            "address_2": "SUITE 200",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504423",
            "telephone_number": "209-214-7053",
            "fax_number": "209-523-0764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1262 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364962",
            "telephone_number": "209-214-7053",
            "fax_number": "209-523-0764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BLISS",
        "middle_name": "WATSON",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2011-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "G59282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "033099502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Jon Chew, RPH
• Young Soo Choi, DDS
• Sukalpa Chowdhury, M.D.
• Seung Ho Chung, DDS
• Rudy Ciccarelli, DDS
• Elizabeth Ann Cliburn, DO
• Keith Clifton
• Derielle K Coleman, LCSW
• Ilene Collins
• Nicole Lee Collman, RN, NP, CNS

• Sports Medicine (Orthopaedic Surgery) Physician in Manteca, CA
• Providers in Manteca, CA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2011; 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.