Individual
DR. CHAD LEROY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3865 JACKSON ST, RIVERSIDE, CA 92503-3919
(951) 352-5666
(951) 352-5445
Mailing address
PO BOX 661987, ARCADIA, CA 91066-1987
(626) 447-0296
(626) 447-6057
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A70662
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A706620
—
CA
Enumeration date
06/15/2006
Last updated
06/13/2008
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