| Dwight S. Clarke, Md, Pllc | |
|
340 E Palm Ln Ste 260 Phoenix AZ 85004-4603 | |
| (602) 254-1136 | |
| (602) 279-1720 |
| Full Name | Dwight S. Clarke, Md, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 340 E Palm Ln, Phoenix, Arizona |
| Authorized Official Name and Position | Bobbie Ronsman (CREDENTIALING MGR) |
| Authorized Official Contact | 6023950718 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dwight S. Clarke, Md, Pllc Po Box 39179 Phoenix AZ 85069-9179 Ph: (602) 395-0718 | Dwight S. Clarke, Md, Pllc 340 E Palm Ln Ste 260 Phoenix AZ 85004-4603 Ph: (602) 254-1136 |
| NPI Number | 1114150778 |
|---|---|
| Provider Enumeration Date | 08/31/2009 |
| Last Update Date | 07/14/2011 |
| Medicare PECOS PAC ID | 4688717754 |
|---|---|
| Medicare Enrollment ID | O20100211000571 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114150778 | NPI | - | NPPES |
| 859142 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Dwight S Clarke |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1477555845 PECOS PAC ID: 4880677871 Enrollment ID: I20040610001014 |
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