Individual
GLENN L. CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4250 HOSPITAL DR, MARIANNA, FL 32446-1917
(850) 718-2597
(850) 718-2551
Mailing address
PO BOX 1128, JENNINGS, LA 70546-1128
(337) 824-4403
(337) 824-9731
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME42096
FL
Other
Enumeration date
09/13/2005
Last updated
07/08/2007
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