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Individual
GARRY ANDREW CLARK
Active
Individual
GARRY ANDREW CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
01361
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080082594
MEDICARE RAILROAD INDIVIDUAL NUMBER
IA
01
—
1528001492
ST LUKES GROUP NPI
IA
01
—
21964
ST LUKES GROUP PTAN
IA
01
—
21964001
ST LUKES INDIVIDUAL PTAN
IA
01
—
CG1061
MEDICARE RAILROAD GROUP NUMBER
IA
Enumeration date
01/11/2006
Last updated
01/26/2012
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