Provider Demographics
NPI:1326625369
Name:CLARK, VICTORIA WILSON (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:WILSON
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 C T SWITZER SR DR STE 306
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4535
Mailing Address - Country:US
Mailing Address - Phone:228-822-6368
Mailing Address - Fax:228-207-3842
Practice Address - Street 1:2781 C T SWITZER SR DR STE 306
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4535
Practice Address - Country:US
Practice Address - Phone:228-822-6368
Practice Address - Fax:228-207-3842
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-4294207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program