IndividualActive
Charles Clark, MD
NPI 1114346434 · Orthopaedic Surgery Physician · Nampa, ID
Provider details
- NPI number
- 1114346434
- Entity type
- Individual
- Primary specialty
- Orthopaedic Surgery PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- M-15579 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
9850 W St Lukes Dr
Nampa, ID 83687-7912
Phone: (208) 706-2663
Fax: (208) 489-4300
Approximate (ZIP-level) locationGet directions
Mailing address
2718 W Jetton Ave
Tampa, FL 33629-5327
Registry dates
- Enumerated
- 2014-04-15
- Last updated
- 2021-01-13
- Certified
- 2021-01-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.