Individual
MR. GARY D CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
12303 DEPAUL DRIVE, BRIDGETON, MO 63044
(314) 344-7049
(314) 344-7073
Mailing address
12303 DEPAUL DRIVE, BRIDGETON, MO 63044
(314) 344-7049
(314) 344-7073
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN057425
MO
367500000X
Certified Registered Nurse Anesthetist
057425
MO
Other
Enumeration date
11/11/2005
Last updated
09/11/2025
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