SHANE T CLARK — Medicare Enrolled Provider (ORDER AND REFERRING ONLY - DENTIST, NM)
SHANE T CLARK — Medicare Enrolled Provider (ORDER AND REFERRING ONLY - DENTIST, NM) is one of 9,000 enrolled providers in the MedicareEnroll dataset. Key details — Name: SHANE T CLARK; Type: Individual; NPI: 1003220203.
| Name | SHANE T CLARK |
|---|---|
| Type | Individual |
| NPI | 1003220203 |
| Provider type | ORDER AND REFERRING ONLY - DENTIST |
| State | NM |
| Enrollment ID | I20150805006536 |
| Multiple NPI flag | N |
| Source | CMS Medicare FFS Public Provider Enrollment (PECOS) |
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