Individual
MR. RYAN PATRICK CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
309 W SAINT LOUIS ST, WEST FRANKFORT, IL 62896-2099
(618) 932-2200
Mailing address
132 HOUSTON ST, SAINT CHARLES, MO 63301-1620
(636) 293-2038
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2014009216
MO
363AM0700X
Medical Physician Assistant
Primary
085005075
IL
Other
Enumeration date
04/02/2014
Last updated
08/16/2014
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