Individual
DR. RON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 237-9294
(574) 237-9259
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 237-9294
(574) 237-9259
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01051209A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000492324
ANTHEM BLUE CROSS
IN
Enumeration date
07/08/2005
Last updated
06/09/2008
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