Individual
DR. GARRETT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5401 PEACH ST, SUITE 3500, ERIE, PA 16509-2601
(814) 868-2179
(814) 868-2346
Mailing address
1 LECOM PL, ERIE, PA 16505-2571
(814) 868-2522
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS014422
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022612880004
—
PA
Enumeration date
07/24/2008
Last updated
03/08/2019
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