Individual
BRYAN BRET CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
842 E MAIN ST, MEDFORD, OR 97504-7134
(801) 870-0588
Mailing address
842 E MAIN ST, MEDFORD, OR 97504-7134
(801) 870-0588
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD1811394
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2013
Last updated
03/28/2017
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