Individual
DONALD LESTER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 UNIVERSITY BLVD, DAYTON, OH 45435-0001
(937) 245-7200
(937) 245-7922
Mailing address
725 UNIVERSITY BLVD, DAYTON, OH 45435-0001
(937) 245-7100
(937) 245-7999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036-114287
IL
207Q00000X
Family Medicine Physician
Primary
35-120123
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0073290
—
OH
05
—
036114287
—
IL
Enumeration date
08/16/2005
Last updated
04/01/2013
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