NPI 1407893795 · live from the CMS NPI Registry
Kirby P Clark, M.D.
Radiology, Diagnostic Radiology in Waterloo, IA. National Provider Identifier 1407893795, active.
NPI record
| NPI | 1407893795 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 4006 Johnathan St, Waterloo, IA 50701 |
| Practice phone | 319-236-2700 |
| Mailing address | Po Box 2758, Waterloo, IA 50704 |
| Enumerated | June 2, 2006 |
| Last updated | November 21, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology | 2085R0202X | 42049-20 (WI) |
| Radiology, Diagnostic Radiology | 2085R0202X | 036126457 (IL) |
| Radiology, Diagnostic Radiology primary | 2085R0202X | 35956 (IA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.