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Individual
PAUL R CLARK
Active
Individual
PAUL R CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ORTHOTIST
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1537369
—
MA
01
—
375354
DME
MA
Enumeration date
10/17/2006
Last updated
07/09/2007
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