Provider Demographics
NPI:1316960669
Name:CLARKE, BRIAN DAVID (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 CLEARVISTA DR
Mailing Address - Street 2:# 375
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-5601
Mailing Address - Country:US
Mailing Address - Phone:317-621-2100
Mailing Address - Fax:317-621-2105
Practice Address - Street 1:7250 CLEARVISTA DR
Practice Address - Street 2:# 375
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5601
Practice Address - Country:US
Practice Address - Phone:317-621-2100
Practice Address - Fax:317-621-2105
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E44307Medicare UPIN
IN246360AMedicare ID - Type Unspecified