Individual
MR. JOHN RILEY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2700 LIGHT RD APT 102, OSWEGO, IL 60543-9231
(415) 516-8668
Mailing address
2700 LIGHT RD APT 102, OSWEGO, IL 60543-9231
(415) 516-8668
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085.007136
IL
Other
Enumeration date
06/13/2019
Last updated
08/02/2019
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