Individual
MR. MICHAEL DWAYNE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
619 CLARENCE ST APT 5, LAKE CHARLES, LA 70601-5370
(337) 721-8070
(337) 721-8060
Mailing address
619 CLARENCE ST APT 5, LAKE CHARLES, LA 70601-5370
(337) 721-8070
(337) 721-8060
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
LA
Other
Enumeration date
03/12/2008
Last updated
03/12/2008
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