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Individual
BRADLEY A CLARK
Active
Individual
BRADLEY A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02005391A
IN
207RC0000X
Cardiovascular Disease Physician
02005391A
IN
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
02005391A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/21/2012
Last updated
06/14/2022
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