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Individual
TERALYNN S CLARK
Active
Individual
TERALYNN S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
4316
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007400
BCBS
SD
05
—
235822100
—
MN
05
—
5707122
—
SD
01
—
59F05CL
BCBS
MN
Enumeration date
07/28/2006
Last updated
02/22/2013
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