Provider Demographics
NPI:1174572697
Name:CLAWSON, MARK CAMPION (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CAMPION
Last Name:CLAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:901 N CURTIS RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1338
Mailing Address - Country:US
Mailing Address - Phone:208-342-4263
Mailing Address - Fax:208-375-0597
Practice Address - Street 1:901 N CURTIS RD
Practice Address - Street 2:SUITE 304
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1338
Practice Address - Country:US
Practice Address - Phone:208-342-4263
Practice Address - Fax:208-375-0597
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM5840207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID58404OtherBLUE CROSS
ID200040400OtherTRAVELERS MEDICARE
IDD87366Medicare UPIN
ID000010005987OtherREGENCE BLUE SHIELD
IDP00443069OtherTRAVELERS MEDICARE
ID1124579Medicare ID - Type Unspecified
ID003621200Medicaid