Clinton Clark Dpm LLC
Clinton Clark Dpm LLC is a healthcare organization registered as Foot & Ankle Surgery Podiatrist in Boise, ID, holding Type 2 (organization) NPI 1104975168 since 2007. The authorized official on file is Clinton Clark, Owner.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1104975168 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Clinton Clark Dpm LLC |
| Practice address | 6051 N EAGLE RD, Boise, ID, 83713 |
| Phone | 2089384670 |
| Fax | 2089384675 |
| Enumeration date | 2007-01-09 |
| Last updated in NPPES | 2020-08-22 |
Authorized official
| Name | Clinton Clark |
|---|---|
| Title | Owner |
| Phone | 2089284670 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 213ES0103X | Foot & Ankle Surgery Podiatrist | Primary | — | — |
Copy-ready billing details
Provider: Clinton Clark Dpm LLC NPI: 1104975168 Taxonomy: 213ES0103X (Foot & Ankle Surgery Podiatrist) Address: 6051 N EAGLE RD, Boise, ID, 83713
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1063462075 | Gary Millward | Individual | Podiatrist | Boise, ID |
| 1578514618 | Scott Graviet | Individual | Podiatrist | Boise, ID |
| 1982711578 | Boise Podiatry Clinic, P. A. | Organization | Primary Podiatric Medicine Podiatrist | Boise, ID |
| 1700099694 | Heidi Van Giffen | Individual | Denturist | Boise, ID |
| 1588002547 | Dustin Portela | Individual | Dermatology Physician | Boise, ID |
| 1154870251 | Jacob Tebbs | Individual | Medical Physician Assistant | Boise, ID |
| 1750223475 | 1st Class Dentures, LLC | Organization | Denturist | Boise, ID |
| 1720920457 | Dana Triplitt | Individual | Denturist | Boise, ID |
Verify this record
Cross-check NPI 1104975168 against the authoritative CMS record: view Clinton Clark Dpm LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is the NPI number for Clinton Clark Dpm LLC?
Who is the authorized official for Clinton Clark Dpm LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2020-08-22.