Active NPI
Derrel W Clarke, MD
- Pediatrics Physician
- Logan, UT
National Provider Identifier
1902812829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 1863221205
- Practice address
- 1350 N 500 E
Logan, UT 84341-2400 - Phone
- (435) 792-1940
- Fax
- (435) 792-1692
- NPI assigned
- Jul 31, 2006
- Last updated
- Oct 14, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 1863221205 | UT | Primary |
Addresses
Primary practice location
1350 N 500 E
Logan, UT 84341-2400
Mailing address
1350 N 500 E
Logan, UT 84341-2400
Phone (435) 792-1940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1863221205 | UT | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223942400000",
"number": "1902812829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 N 500 E",
"city": "LOGAN",
"state": "UT",
"postal_code": "843412400",
"telephone_number": "435-792-1940",
"fax_number": "435-792-1692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 N 500 E",
"city": "LOGAN",
"state": "UT",
"postal_code": "843412400",
"telephone_number": "435-792-1940",
"fax_number": "435-792-1692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKE",
"first_name": "DERREL",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2008-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "UT",
"license": "1863221205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.