DR. GORDON BLAKE CLARK (NPI# 1417937145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417937145 |
| Entity Type | Individual |
| Full Name | DR. GORDON BLAKE CLARK |
| Credential | MD |
| Practice Address |
21624 Midland Dr Shawnee KS 66218-9064 |
| Practice Telephone | 9136430075 |
| Practice Fax Number | 9136430077 |
| Mailing Telephone | 9136430075 |
| Mailing Fax Number | 9136430077 |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2011-11-02 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207V00000X | Obstetrics & Gynecology | KS 04-23518 | KS | Allopathic & Osteopathic Physicians |
| Y | 207VB0002X |
Obstetrics & Gynecology Specialization: Obesity Medicine |
04-23518 | KS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | 100305190D | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629116744 | Gordon Michael Clark Sr. | Internal Medicine | 4119 Emerson Ave, Dallas, TX 75205-1144 | 2007-02-01 |
| 1225091523 | Gordon H. Clark Jr. | Psychiatry & Neurology | 161 E Elm St, Yarmouth, ME 04096-7109 | 2006-04-08 |
| 1265546014 | Gordon H Clark | Family Medicine | 820 1st Street, Limon, CO 80828-8082 | 2006-08-18 |
| 1972538932 | Gordon Penner Clark | Emergency Medicine | 809 Turnpike Ave, Clearfield, PA 16830-1232 | 2006-07-11 |
| Street Address |
21624 MIDLAND DR |
| City | SHAWNEE |
| State | KS |
| Zip Code | 66218-9064 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336417831 | Women' S and Family Care Dba Gtc Research | Clinic/Center | 21624 Midland Dr, Shawnee, KS 66218-9064 | 2011-12-12 |
| 1790852135 | Comprehensive Women's Care, Inc. | Obstetrics & Gynecology | 21624 Midland Dr, Shawnee, KS 66218-9064 | 2006-11-29 |
| 1598778854 | Tracy A Clark | Nurse Practitioner | 21624 Midland Dr, Shawnee, KS 66218-9064 | 2006-08-15 |
| 1386689578 | Comprehensive Women's Care, Inc. | Family Medicine | 21624 Midland Dr, Shawnee, KS 66218-9064 | 2006-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568695401 | Judy Ann Wegman | Dietitian, Registered | 18601 Midland Drive, Shawnee, KS 66218 | 2009-08-26 |
| 1790888733 | Alberto Ramon Castaneda | Dentist | 21620 Midland Drive, Suite A, Shawnee, KS 66218 | 2006-09-06 |
| 1205317799 | Calm Connection Counseling, LLC | Clinic/Center | 5905 Longview St, Shawnee, KS 66218-7504 | 2018-08-23 |
| 1245711738 | Candace L Holloman | Counselor | 5905 Longview St, Shawnee, KS 66218-7504 | 2018-08-23 |
| 1124416342 | Shelly Lien | Physical Therapy Assistant | 5934 Theden St, Shawnee, KS 66218-7800 | 2014-12-23 |
| 1770614562 | Valarie Mcneely | Long Term Care Hospital | 5822 Woodstock St, Shawnee, KS 66218-8400 | 2007-03-07 |
| 1750775144 | Kamlesh Trivedi | Pharmacist | 20814 W 72nd Ter, Shawnee, KS 66218-8646 | 2015-03-24 |
| 1205447984 | Brooke Nichole Steiner | Pharmacist | 21702 W 58th St, Shawnee, KS 66218-8933 | 2020-08-14 |
| 1710289418 | Eileen Marita Burrow | Behavioral Analyst | 4905 Lakecrest Dr, Shawnee, KS 66218-8964 | 2010-12-01 |
| 1003168402 | Clint Mcalister | Specialist/Technologist | 6324 Theden St, Shawnee, KS 66218-8975 | 2012-10-09 |
| Find all providers in zip 66218 | ||||
| Taxonomy Code | 207VB0002X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Obesity Medicine |
| A physician who specializes in the treatment of obesity demonstrates competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity. The obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy. The obesity medicine physician utilizes a comprehensive approach, and may include additional resources such as dietitians, exercise physiologists, mental health professionals and bariatric surgeons as indicated to achieve optimal results. Additionally, the obesity medicine physician maintains competency in providing pre- peri- and post-surgical care of bariatric surgery patients, promotes the prevention of obesity, and advocates for those who suffer from obesity. |
| Notes: Source: American Board of Obesity Medicine, www.abom.org [7/1/2015: title and definition modified] Additional Resource: American Society of Bariatric Physicians, www.asbp.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699250621 | Heartland Weight Loss | Obstetrics & Gynecology | 11401 Nall Ave Ste 216, Leawood, KS 66211-1850 | 2018-09-25 |
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| 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.