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Individual
MR. WILLIAM A CLARK
Active
Individual
MR. WILLIAM A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601001772
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C36097
TRAVELERS MEDICARE
—
01
—
0C360971062
MEDICARE
MI
Enumeration date
08/02/2005
Last updated
06/05/2015
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