Individual
KELLAN FITZGERALD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1200 WESTWOOD DR STE F, HAMILTON, MT 59840-2345
(406) 375-2930
(406) 375-4525
Mailing address
1200 WESTWOOD DR, HAMILTON, MT 59840-2345
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MED-PHYS-LIC-71931
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100004016
—
MT
05
—
1134539091
—
ID
Enumeration date
04/30/2014
Last updated
11/12/2024
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