MATTHEW RYAN CLARK (NPI# 1194162230) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194162230 |
| Entity Type | Individual |
| Full Name | MATTHEW RYAN CLARK |
| Credential | M.D. |
| Practice Address |
815 Sw Bond St Bend OR 97702-3593 |
| Mailing Address |
1390 S Potomac St Ste 124 Aurora CO 80012-4529 |
| Practice Telephone | 5413822811 |
| Mailing Telephone | 3033688611 |
| Mailing Fax Number | 3033689791 |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2020-04-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | MD195653 | OR | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | DR.0060565 | CO | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
MD195653 | OR | Allopathic & Osteopathic Physicians |
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
DR.0060565 | CO | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
MD195653 | OR | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
DR.0060565 | CO | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9500 Euclid Ave # A61, Cleveland, OH 441955000 | 2164445933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033578653 | Matthew Mitchell Clark | Student in an Organized Health Care Education/Training Program | 2644 Crystal Falls Rd, Lexington, KY 40509-4208 | 2016-02-11 |
| 1154787844 | Matthew Clark | Chiropractor | 5250 S Commerce Dr Ste 155, Murray, UT 84107-5379 | 2016-01-11 |
| 1811001126 | Matthew David Ayers Clark | Psychologist | 7150 Kalamazoo Ave Se, Ste C, Caledonia, MI 49316-9126 | 2006-08-17 |
| 1215993308 | Matthew Alexander Clark | Internal Medicine | Ute Mountain Ute Health Center, Complex B Rustling Willow Street, Towaoc, CO 81334-0049 | 2006-04-26 |
| 1407341134 | Matthew Howard Clark | Nurse Practitioner | 200 1st St Sw, Rochester, MN 55905 | 2018-06-25 |
| 1639674591 | Matthew Anthony Clark | Student in an Organized Health Care Education/Training Program | 22 Bramhall St, Portland, ME 04102-3134 | 2018-03-24 |
| 1588104913 | Matthew Louis Clark | Pharmacist | 4747 Sawmill Rd, Columbus, OH 43220-2490 | 2017-03-04 |
| 1679949184 | Matthew Clark | Optometrist | 2792 E 146th St, Carmel, IN 46033-7718 | 2015-08-19 |
| 1902288806 | Matthew Lewis Clark | Dermatology | 8245 Holly Rd Ste 101, Grand Blanc, MI 48439-2443 | 2015-06-26 |
| 1417353996 | Matthew Clark | Counselor | 360 Bloomfield Ave, Ste 301, Windsor, CT 06095-2700 | 2014-11-12 |
| Street Address |
815 SW BOND ST |
| City | BEND |
| State | OR |
| Zip Code | 97702-3593 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396745303 | Jill M Olinger | Dermatology | 815 Sw Bond St, Bend, OR 97702 | 2005-08-01 |
| 1114395779 | Neuromusculoskeletal Center of The Cascades PC | Clinic/Center | 815 Sw Bond St, Bend, OR 97702-3593 | 2015-09-11 |
| 1932495488 | Craig Robert Laws | Family Medicine | 815 Sw Bond St, Suite 300, Bend, OR 97702-3593 | 2011-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629676259 | Amy Michelle Anderson | Counselor | 233 Sw Wilson Ave, Ste 201, Bend, OR 97702 | 2020-10-15 |
| 1386259463 | Jacob Rehder | Counselor | 19717 Mt Batchelor Dr, #226, Bend, OR 97702 | 2020-09-15 |
| 1497385215 | Capacity Performance Therapy | Physical Medicine & Rehabilitation | 61125 Lodgepole Dr., Bend, OR 97702 | 2020-01-21 |
| 1962041707 | Shift Bend Functional Medicine | Family Medicine | 151 Sw Shevlin Hicks Dr, Suite #1, Bend, OR 97702 | 2019-12-26 |
| 1609435049 | Praxis Medical Group Inc | Orthopaedic Surgery | 1140 Sw Simpson Avenue, Suite 100, Bend, OR 97702 | 2019-06-10 |
| 1013485754 | Elana Leah Pesah | Social Worker | 138 Maaglei Harim Levin, Jerusalem, ISRAEL 97702 | 2018-11-12 |
| 1104303239 | Kyleigh Mcvey | Massage Therapist | 999 Sw Disk Dr, Bend, OR 97702 | 2018-07-21 |
| 1477042869 | Siloe Castaneda Huerta | Counselor | 1340 Nw Wall, Bend, Or, Bend, OR 97702 | 2018-05-02 |
| 1164910808 | Rebecca M Joyce | Social Worker | 1011 Sw Emkay Dr. Suite 101, Bend, OR 97702 | 2018-04-27 |
| 1093217978 | Jennifer Bury | Acupuncturist | 296 Sw Columbia St Ste D1, Bend, OR 97702 | 2018-03-06 |
| Find all providers in zip 97702 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447713573 | Dermatology Health Specialists, PC | Dermatology | 1693 Sw Chandler Ave Ste 250, Bend, OR 97702-3231 | 2019-04-06 |
| 1780846501 | Bend Memorial Clinic PC | Dermatology | 2600 Ne Neff Rd, Bend, OR 97701-6337 | 2008-07-02 |
| 1184643249 | William J Delgado | Dermatology | 2705 Ne Conners Ave, Bend, OR 97701-6904 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871574947 | Edgar Maeyens | Dermatology | 375 Park Ave, Suite 5, Coos Bay, OR 97420-2242 | 2005-11-07 |
| 1972913259 | Lindsey Fix | Dermatology | 1605 G St, Springfield, OR 97477 | 2014-05-07 |
| 1558515494 | Jay Y Park Md, PC | Dermatology | 360 S Garden Way Ste 230, Eugene, OR 97401-8173 | 2008-11-05 |
| 1700081742 | Richard I. Ecker | Dermatology | 706 Ne Evans St, Mcminnville, OR 97128-3926 | 2007-06-19 |
| 1396845814 | Parwathi Vasudeva Paniker | Dermatology | 3600 N Interstate Ave, Portland, OR 97227-1106 | 2006-09-24 |
| 1205805405 | Stephen N Snow | Dermatology | 3600 N Interstate Ave, Dermatology/mohs Surg Central Interstate Medical Office, Portland, OR 97227-1106 | 2006-03-17 |
Please comment or provide details below to improve the information on MATTHEW RYAN CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.