Walter D Clark, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

0048 Issued in AL

Practice address

805 St. Vincent's Drive
Suite 420
Birmingham, AL 35205-2704

Phone

(205) 324-8511

Fax

(205) 314-8551

NPI assigned

Jan 5, 2006

Last updated

Nov 13, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384300800000",
    "number": "1700864238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 ST. VINCENT'S DRIVE",
            "address_2": "SUITE 420",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352052704",
            "telephone_number": "205-324-8511",
            "fax_number": "205-314-8551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 ST. VINCENT'S DRIVE",
            "address_2": "SUITE 420",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352052704",
            "telephone_number": "205-324-8511",
            "fax_number": "205-314-8551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "WALTER",
        "middle_name": "D",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2013-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AL",
            "license": "0048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CL000070338",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051070338",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Owen Matthew Clark, MD
• Sally Marie Clark, MS, CCC-SLP
• Sara Emily Allen Clark, M.D.
• Stephen T Clark, M.D.
• Timothy M. Clark, CRNA
• Zachary Eugene Clark, M.D.
• Carmella Mae Clarke
• Christy R Clarke, CRNA
• Paul Clarke, CRNP PC
• Stephen Clarkson

• Podiatrist in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Podiatrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; 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.