Provider Demographics
NPI:1982407730
Name:CLARK, CARSON THOMAS (DO)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:THOMAS
Last Name:CLARK
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 E 5600 S
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6935
Mailing Address - Country:US
Mailing Address - Phone:801-726-2900
Mailing Address - Fax:
Practice Address - Street 1:4403 HARRISON BLVD STE 700A
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3295
Practice Address - Country:US
Practice Address - Phone:801-726-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program