Randy R Clark, M.D.
Orthopaedic Surgery, Sports Medicine in St George, UT. Individual provider (NPI-1).
NPI number1679781140
StatusActive
Last updated in NPPESMar 20, 2025
Details
- NPI
- 1679781140
- Entity type
- Individual (NPI-1)
- Name
- Randy R Clark
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 18, 2007
- Certification date
- Mar 20, 2025
- Last updated
- Mar 20, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207XX0005X | Orthopaedic Surgery, Sports Medicine | 8203740-1205 | UT | Yes |
| 207X00000X | Orthopaedic Surgery | 8203740-1205 | UT |
Practice location
2825 E Mall DrSt George, UT 84790-1954
Phone 435-628-9393 · Fax 435-628-9382
Mailing address
1055 N 500 WAttn: Credentialing
Provo, UT 84604-3305
Phone 801-354-8225 · Fax 801-418-0941
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