Individual
MR. STEVEN J CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 GOOD SAMARITAN WAY, SUITE 235, MOUNT VERNON, IL 62864-2408
(618) 899-3980
(618) 899-4793
Mailing address
2 GOOD SAMARITAN WAY, SUITE 235, MOUNT VERNON, IL 62864-2408
(618) 899-3980
(618) 899-4793
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
036086955
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257001700
—
FL
Enumeration date
07/06/2006
Last updated
10/21/2013
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