Provider Demographics
NPI:1699786376
Name:CLARK, CAITLIN (MD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COLORADO BLVD
Mailing Address - Street 2:SUITE 179
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4084
Mailing Address - Country:US
Mailing Address - Phone:303-321-7526
Mailing Address - Fax:
Practice Address - Street 1:7155 E 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-1630
Practice Address - Country:US
Practice Address - Phone:303-321-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16110207V00000X
NMMD2021-1138207V00000X
CODR43725207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77221559Medicaid
NM55089062Medicaid