Individual
ANTHONY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2600 SIXTH STREET SW, OHIO HOSPITAL BASED PHYSICIAN CORP, CANTON, OH 44710
(330) 363-7462
(330) 363-7679
Mailing address
PO BOX 80690, CANTON, OH 44708-0690
(330) 363-7444
(330) 363-7770
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
KN237880
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.03168
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2113779
—
OH
Enumeration date
05/27/2006
Last updated
07/19/2022
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