CHRISTOPHER B. CLARK M.D.

Allergy and Immunology

Gallipolis, Ohio

Provider NPI: 1639123995

Provider Information:
 CHRISTOPHER B. CLARK M.D.


Practice Location:
100 JACKSON PIKE  GALLIPOLIS, OH 45631 US
Tel: 740-446-5360  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	207K00000X	Physicians Allergy & Immunology	WV	21461
Y	207K00000X	Physicians Allergy & Immunology	OH	35-08-2565

Other Provider Identifiers:

Issuer	Number	State	Type
OH MEDICAID CARESOURCE	310917085113	OH	01
	1810204000	WV	05
OH MEDICAID MOLINA	2434771	OH	01
OH MEDICAID UNISON	000000181421	OH	01
	2434771	OH	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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