Individual
JEFFREY M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
600 NE 92ND AVE, VANCOUVER, WA 98664-3225
(360) 514-2142
(360) 514-6820
Mailing address
FILE 742997, LOS ANGELES, CA 90074-2997
(360) 514-2142
(360) 514-6820
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10002763
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8357758
—
WA
Enumeration date
06/05/2006
Last updated
09/26/2012
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