Individual
RICK C. CLARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
220 BANNOCK ST, SUITE 306, MALAD CITY, ID 83252-1256
(208) 766-2600
(208) 766-4258
Mailing address
PO BOX 126, SUITE 306, MALAD CITY, ID 83252-0126
(208) 766-2231
(208) 766-4819
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-749
ID
Other
Enumeration date
11/10/2005
Last updated
11/16/2021
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