Provider Demographics
NPI:1053355628
Name:CLARK, THOMAS F (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1086 7TH AVE SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1997
Mailing Address - Country:US
Mailing Address - Phone:541-928-4249
Mailing Address - Fax:541-928-2942
Practice Address - Street 1:1086 7TH AVE SW
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1997
Practice Address - Country:US
Practice Address - Phone:541-928-4249
Practice Address - Fax:541-928-2942
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-04-10
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Provider Licenses
StateLicense IDTaxonomies
ORMD10126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD73059Medicare UPIN