Individual
DR. CHARLES MALCOLM CLARK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2802 LAFAYETTE ROAD SUITE 13, EAGLEDALE HEALTH CENTER, INDIANAPOLIS, IN 46222-2112
(317) 923-7510
(317) 923-7518
Mailing address
2802 LAFAYETTE ROAD SUITE 13, EAGLEDALE HEALTH CENTER, INDIANAPOLIS, IN 46222-2112
(317) 923-7510
(317) 923-7518
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
01020086A
IN
Other
Enumeration date
09/26/2011
Last updated
09/26/2011
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