Provider Demographics
NPI:1902497662
Name:CLARK, MAURICE DURON (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:DURON
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 WOOD OWL ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-2470
Mailing Address - Country:US
Mailing Address - Phone:330-933-4296
Mailing Address - Fax:
Practice Address - Street 1:2817 WOOD OWL ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-2470
Practice Address - Country:US
Practice Address - Phone:330-933-4296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUL3520173747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant