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Individual

LOGAN S CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
8211 W 3500 S, MAGNA, UT 84044-1851
(801) 250-9638
(801) 250-3204
Mailing address
3336 PIONEER PKWY, SUITE 201, WEST VALLEY, UT 84120-2000
(801) 250-9638
(801) 417-0063

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5262016-1206
UT

Other

Enumeration date
03/28/2008
Last updated
03/28/2008
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