Individual
DR. PATRICIA L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11050 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1739
(833) 724-8326
(260) 425-6845
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01094461A
IN
208600000X
Surgery Physician
51951
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135033
—
AZ
Enumeration date
07/27/2006
Last updated
10/02/2024
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