Provider Demographics
NPI:1871754184
Name:ELEANOR A. CLARK, MD,PC
Entity type:Organization
Organization Name:ELEANOR A. CLARK, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-836-1760
Mailing Address - Street 1:1821 N TREKELL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1705
Mailing Address - Country:US
Mailing Address - Phone:520-836-1760
Mailing Address - Fax:520-836-3033
Practice Address - Street 1:1821 N TREKELL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1705
Practice Address - Country:US
Practice Address - Phone:520-836-1760
Practice Address - Fax:520-836-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16389207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty