DR. GARY BRUCE CLARK (NPI# 1902962939) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902962939 |
| Entity Type | Individual |
| Full Name | DR. GARY BRUCE CLARK |
| Credential | MD |
| Practice Address |
1790 30th St Suite 230 Boulder CO 80301-1022 |
| Mailing Address |
12541 Grove St Broomfield CO 80020-5869 |
| Practice Telephone | 3034445131 |
| Practice Fax Number | 3034445131 |
| Mailing Telephone | 7208875726 |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 20926 | CO | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548876048 | Gary Lee Clark | In Home Supportive Care | 71312 Woods Ave, Martins Ferry, OH 43935-3104 | 2020-09-20 |
| 1588085302 | Gary Marvin Clark | Pharmacist | 15227 Aurora Cir, Urbandale, IA 50323-2472 | 2013-12-20 |
| 1487855961 | Gary K. Clark | Dentist | 9730 S 700 E Ste 106, Sandy, UT 84070-4503 | 2007-05-30 |
| 1174649172 | Gary Clark | Social Worker | 502 W 143rd St, Suite 3a, New York, NY 10031-6507 | 2007-03-21 |
| 1912022484 | Gary Mike Clark | Marriage & Family Therapist | 8911 3rd Street Rd, Louisville, KY 40272-2501 | 2007-03-20 |
| 1013987759 | Gary Wayne Clark | Family Medicine | 125 Canton Rd Nw, Carrollton, OH 44615-1009 | 2006-01-25 |
| 1609861152 | Gary W Clark | Podiatrist | 166 W 1325 N, Suite 300, Cedar City, UT 84721-7792 | 2005-09-12 |
| 1972140713 | Gary Clark | Behavior Technician | 100 Spenryn Dr, Madison, AL 35758-1890 | 2019-11-27 |
| 1043514540 | Gary D Clark | Pharmacist | 2701 S Nc 127 Hwy, Hickory, NC 28602-9130 | 2010-12-27 |
| 1518042274 | Gary C. Clark | Surgery | 7901 Frost St, Sharp Memorial Hospital, San Diego, CA 92123-2701 | 2006-10-25 |
| Street Address |
1790 30TH ST SUITE 230 |
| City | BOULDER |
| State | CO |
| Zip Code | 80301-1022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831184381 | Myra Beth Tuckerman | Family Medicine | 1790 30th St, Suite 308, Boulder, CO 80301-1022 | 2005-09-12 |
| 1649883752 | Abigail Mucklow | Occupational Therapist | 1790 30th St, Boulder, CO 80301-1022 | 2020-08-28 |
| 1760867089 | Ramya Shyam | Speech-Language Pathologist | 1790 30th St, Suite 120, Boulder, CO 80301-1022 | 2015-07-28 |
| 1205215662 | Boulder Cognitive and Linguistic Center Inc | Speech-Language Pathologist | 1790 30th St, Suite 120, Boulder, CO 80301-1022 | 2015-05-19 |
| 1316355365 | Hilary Booco | Speech-Language Pathologist | 1790 30th St, Suite 120, Boulder, CO 80301-1022 | 2014-07-22 |
| 1992072094 | Ricardo Esparza, Ph.d., Pllc | Clinic/Center | 1790 30th St, Suite 120, Boulder, CO 80301-1022 | 2011-11-17 |
| 1194012583 | Gudrun A Dilger | Counselor | 1790 30th St, Suite 245, Boulder, CO 80301-1022 | 2011-07-06 |
| 1174769665 | Family Home Health LLC | Day Training/Habilitation Specialist | 1790 30th St, Suite 350, Boulder, CO 80301-1022 | 2009-01-05 |
| 1386899169 | Ruth Wharton | Counselor | 1790 30th St, Suite 200, Boulder, CO 80301-1022 | 2008-11-20 |
| 1679735732 | Jacob Hans | Chiropractor | 1790 30th St, Suite 270, Boulder, CO 80301-1022 | 2008-06-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265031454 | Jonathan William Garson | Social Worker | 1790 30th St., Boulder, CO 80301 | 2020-10-20 |
| 1164048161 | Crossroads Medical Center | Family Medicine | 2760 29th St., Suite 28, Boulder, CO 80301 | 2020-06-25 |
| 1316585045 | Karissa Marlene Smith | Registered Nurse | 4770 Pearl Street, Suite A, Boulder, CO 80301 | 2019-12-12 |
| 1184273864 | National Doula Network | Doula | 5918 Gunbarrel Ave Apt E, Boulder, CO 80301 | 2019-09-05 |
| 1861047086 | Samuel Shay | Chiropractor | 1750 30th St, Ste 1, #226, Boulder, CO 80301 | 2019-08-05 |
| 1124504808 | Be Free Live Now LLC | Social Worker | 2945 Center Creen Court, Suite G211, Boulder, CO 80301 | 2018-07-16 |
| 1720596703 | Janis Dochterman | Counselor | 5378 Sterling Drive, Studio #3, Boulder, CO 80301 | 2018-01-12 |
| 1033628631 | Whitney Shea | Physical Therapy Assistant | 3020 Carbon Place, #330, Physical Therapy of Boulder, Boulder, CO 80301 | 2017-09-26 |
| 1538688908 | Kyle N. Daniel Dds PC | Dentist | 2830 Valmont Rd, Boulder, CO 80301 | 2017-09-16 |
| 1497205231 | Jenna Orosco | Counselor | 2945 Center Green Ct. Suite H, Suite H, Boulder, CO 80301 | 2016-10-05 |
| Find all providers in zip 80301 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871068528 | Rocky Mountain Regenerative Medicine, Pllc | General Practice | 2260 Baseline Rd Ste 102, Boulder, CO 80302-7740 | 2018-10-09 |
| 1841548674 | Edward Cosgriff | General Practice | 5920 Longbow Dr, Boulder, CO 80301-3202 | 2012-08-28 |
| 1164790994 | Mary Dan Eades | General Practice | 6525 Gunpark Dr # 150-504, Boulder, CO 80301-3346 | 2011-12-07 |
| 1376872259 | Richard Steinberg | General Practice | 2939 10th St, Boulder, CO 80304-3019 | 2009-12-23 |
| 1669023495 | Jordan Urban | General Practice | 703 Walnut St, Boulder, CO 80302-5032 | 2019-09-23 |
| 1326396599 | Michael Robert Eades | General Practice | 6525 Gunpark Dr # 150-504, Boulder, CO 80301-3346 | 2012-08-20 |
| 1871735381 | Teresa Rebibo Fox | General Practice | 4840 Riverbend Rd, 100, Boulder, CO 80301-2659 | 2009-03-30 |
| 1932340494 | Larry Eckstein, M.d., P.C. | General Practice | 2760 29th St, Suite 2-d, Boulder, CO 80301-1214 | 2009-03-13 |
| 1649497066 | Diana L Wetzbarger | General Practice | 580 Mohawk Dr, Boulder, CO 80303-3712 | 2007-04-19 |
| 1821000704 | Larry Eckstein | General Practice | 2760 29th St, Suite 2-d, Boulder, CO 80301-1214 | 2006-08-12 |
| Find all providers in BOULDER | ||||
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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.