Individual
CHARLES CLARK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9850 W ST LUKES DR, NAMPA, ID 83687-7912
(208) 706-2663
(208) 489-4300
Mailing address
2718 W JETTON AVE, TAMPA, FL 33629-5327
(813) 784-0002
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M-15579
ID
Other
Enumeration date
04/15/2014
Last updated
01/13/2021
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