NPI 1679781140 · live from the CMS NPI Registry
Randy R Clark, M.D.
Orthopaedic Surgery, Sports Medicine in St George, UT. National Provider Identifier 1679781140, active.
NPI record
| NPI | 1679781140 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Orthopaedic Surgery, Sports Medicine 207XX0005X |
| Practice location | 2825 E Mall Dr, St George, UT 84790 |
| Practice phone | 435-628-9393 |
| Mailing address | 1055 N 500 W, Attn: Credentialing, Provo, UT 84604 |
| Enumerated | May 18, 2007 |
| Last updated | March 20, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Orthopaedic Surgery, Sports Medicine primary | 207XX0005X | 8203740-1205 (UT) |
| Orthopaedic Surgery | 207X00000X | 8203740-1205 (UT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.