Individual
DR. BRADLEY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
423 E ELAINE CIR, INKOM, ID 83245-1716
(208) 251-9482
Mailing address
423 E ELAINE CIR, INKOM, ID 83245-1716
(208) 251-9482
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M-8299
ID
Other
Enumeration date
10/29/2009
Last updated
10/29/2009
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