Gary Bruce Clark, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

20926 Issued in CO

Practice address

1790 30TH St
Suite 230
Boulder, CO 80301-1022

Phone

(303) 444-5131

Fax

(303) 444-5131

NPI assigned

Dec 27, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Sep 24, 2015 through Sep 24, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902962939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12541 GROVE ST",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800205869",
            "telephone_number": "720-887-5726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 30TH ST",
            "address_2": "SUITE 230",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011022",
            "telephone_number": "303-444-5131",
            "fax_number": "303-444-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GARY",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CO",
            "license": "20926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyrstin Clare, LSW
• Alice M Clark, MA, LPC, CACIII
• Christy Lynn Clark, M.A. LPC
• Deborah Clark I
• Denise Maureen Clark, N.D.
• James Emit Clark, MD
• Jennifer Clark
• Timothy M Clark, MD
• Claude H. Burrow, M.D.
• Clausen Therapy, PLLC

• General Practice Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• General Practice Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.