John Robert Clark MD PC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

4301062758 Issued in MI

Legal business name

JOHN ROBERT CLARK MD PC

Practice address

600 S Lakeview Ave Ste 207
Sturgis, MI 49091-2372

Phone

(269) 659-4646

Fax

(269) 651-2210

NPI assigned

Nov 22, 2010

Organization subpart

No

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

Authorized official

Name

Dr. John Robert Clark, M.D.

Title

President

Phone

(269) 659-4646

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1290384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290556800000",
    "number": "1700188901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S LAKEVIEW AVE STE 207",
            "city": "STURGIS",
            "state": "MI",
            "postal_code": "490912372",
            "telephone_number": "269-659-4646",
            "fax_number": "269-651-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S LAKEVIEW AVE STE 207",
            "city": "STURGIS",
            "state": "MI",
            "postal_code": "490912372",
            "telephone_number": "269-659-4646",
            "fax_number": "269-651-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN ROBERT CLARK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-22",
        "last_updated": "2010-11-24",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-659-4646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4301062758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3044976",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Sturgis, MI
• Providers in Sturgis, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2010; 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.