Individual
TYLER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 LINCOLN WAY, COEUR D ALENE, ID 83814-2537
(208) 625-4955
(208) 625-4956
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-4955
(208) 625-4956
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-14362
ID
Other
Enumeration date
04/14/2015
Last updated
04/16/2024
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