EDWARD B CLARK (NPI# 1881775674) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881775674 |
| Entity Type | Individual |
| Full Name | EDWARD B CLARK |
| Credential | MD |
| Practice Address |
100 N Medical Dr Salt Lake City UT 84113-1103 |
| Mailing Address |
Po Box 581100 Salt Lake City UT 84158-1100 |
| Practice Telephone | 8015882000 |
| Mailing Telephone | 8012133800 |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
317634-6002 | UT | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043570732 | Edward Clark | Counselor | 4015 Nine Mcfarland Dr, Suite #175, Alpharetta, GA 30004-8493 | 2012-05-29 |
| 1093028870 | Edward Derby Clark I | Counselor | 1355 Pebblewood Dr, Sacramento, CA 95833-1612 | 2010-07-21 |
| 1053474080 | Edward Joseph Clark IIi | Radiology | 1705 S. Tarboro St, Wilson, NC 27893 | 2006-12-19 |
| 1730294232 | Edward Deallen Clark | Obstetrics & Gynecology | 1600 W College St Ste Ll10, Grapevine, TX 76051-3598 | 2006-08-21 |
| 1205843604 | Edward Mark Clark | Dentist | 5211 Yellowstone Rd, Ste # 1, Cheyenne, WY 82009-4761 | 2006-08-01 |
| 1528074523 | Edward Lee Clark | Dentist | 2727 Sw 17th Pl, Redmond, OR 97756-1297 | 2006-07-31 |
| 1124028311 | Edward C Clark | Ophthalmology | 11355 Pembrooke Sq, Suite 107, Waldorf, MD 20603-4805 | 2005-07-28 |
| 1013917814 | Edward C Clark | Internal Medicine | 311 W 24th St, Suite 402, Erie, PA 16502-2665 | 2005-07-22 |
| 1063072429 | Edward Clark | Technician | 1310 6th St Nw, Washington, DC 20001-3495 | 2019-06-18 |
| 1710490800 | Edward E Clark Jr. | Registered Nurse | 10 Penfield Ave, Akron, OH 44310-2912 | 2017-11-10 |
| Street Address |
100 N MEDICAL DR |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84113-1103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598763112 | Michael Wayne Boyer | Pediatrics | 100 N Medical Dr, Bmt, Salt Lake City, UT 84113-1103 | 2005-07-08 |
| 1679719215 | Kristen Haacke | Nurse Practitioner | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2009-01-04 |
| 1508001736 | Juliann Wintch Allred | Psychiatry & Neurology | 100 N Medical Dr, Clinical Neurosciences Center, Neurology, Salt Lake City, UT 84132-0001 | 2008-12-02 |
| 1811141500 | Jennifer Grace O'donohoe | Student in an Organized Health Care Education/Training Program | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-11-08 |
| 1033362264 | Erin Kristin Zinkhan | Pediatrics | 100 N Medical Dr, Residency Office, Salt Lake City, UT 84113-1103 | 2008-10-31 |
| 1962652966 | Rachael D Rich | Nurse Practitioner | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-09-25 |
| 1528229101 | Julia Kelsey Gunther | Pediatrics | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-06-17 |
| 1225295520 | Primary Children's Medical Center | General Acute Care Hospital | 100 N Medical Dr, Primary Children's Medical Center Pediatric Cardiology, Salt Lake City, UT 84113-1103 | 2008-05-22 |
| 1942476569 | Pediatric Behavioral Health | Pediatrics | 100 N Medical Dr, Peds Behavioral Health, Salt Lake City, UT 84113-1103 | 2008-05-03 |
| 1871769471 | Machelle Ross Bateman | Nurse Practitioner | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2008-05-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386111060 | Melissa Marie Dixon | Psychologist | Primary Children's Hospital Outpatient Services, 81 South Mario Capecchi Drive, Salt Lake City, UT 84113 | 2018-10-31 |
| 1366965618 | Ashley Stuart | Psychologist | 44 North Mario Capecchi Drive, Salt Lake City, UT 84113 | 2017-07-19 |
| 1487945135 | Justin C Wheeler | Pediatrics | 81 N Mario Capecchi Dr Fl 4, Salt Lake City, UT 84113 | 2011-04-29 |
| 1154612117 | Dana Boucek | Pediatrics | 100 North Mario Capecchi Dr., Primary Children's, Salt Lake City, UT 84113 | 2011-04-26 |
| 1285959502 | Anna Katherine Eyre Ermarth | Pediatrics | 81 Mario Capecchi, Salt Lake City, UT 84113 | 2010-03-30 |
| 1457682072 | Elizabeth K Cho | Nurse Practitioner | 100 North Mario Cappechi Dr., Salt Lake City, UT 84113 | 2010-01-21 |
| 1528290848 | Nancy Crandell Brown | Nurse Practitioner | 100 North Mario Cappechi Drive, Salt Lake City, UT 84113 | 2009-08-20 |
| 1679708481 | Primary Children's Medical Center | General Acute Care Hospital | 100 No. Mario Capecchi Drive, Salt Lake, UT 84113 | 2009-05-22 |
| 1467697235 | Tara Hook | Physical Therapist | 100 North Mario Capecchi Dr, Salt Lake City, UT 84113 | 2008-12-09 |
| 1144474768 | Jennifer K Workman | Pediatrics | 100 N Mario Capecchi Drive, Pediatric Crtical Care, Primary Children's Hospital, Salt Lake City, UT 84113 | 2008-11-10 |
| Find all providers in zip 84113 | ||||
| Taxonomy Code | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154612117 | Dana Boucek | Pediatrics | 100 North Mario Capecchi Dr., Primary Children's, Salt Lake City, UT 84113 | 2011-04-26 |
| 1053845339 | Matthew David Beaver | Pediatrics | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2017-04-13 |
| 1447606561 | Bryan Matthew Jepson | Pediatrics | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2016-05-07 |
| 1902260474 | University of Utah Pediatric Services | Pediatrics | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-04-11 |
| 1942664412 | University of Utah Pediatric Services | Pediatrics | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2016-04-11 |
| 1497118764 | Claire Newlon | Pediatrics | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2016-04-03 |
| 1811376569 | Rohin Moza | Pediatrics | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2015-05-28 |
| 1982095105 | Dwight Robertson | Pediatrics | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2015-02-10 |
| 1629411970 | Juan Carlos Samayoa | Pediatrics | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2013-04-16 |
| 1841551140 | Lauren M Andrade | Pediatrics | 100 Mario Capecchi Dr, Salt Lake City, UT 84132-0002 | 2012-06-04 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84113 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.