Provider Demographics
NPI:1194796128
Name:CLARK, PERRIN C (MD)
Entity type:Individual
Prefix:DR
First Name:PERRIN
Middle Name:C
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3732
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:1050 W GRANADA BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8154
Practice Address - Country:US
Practice Address - Phone:386-677-8808
Practice Address - Fax:386-677-9919
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN2444207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIO188ZMedicare UPIN