Individual
DAVID R. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1942 BRAEBURN CIR, SALEM, VA 24153-7388
(540) 444-1240
Mailing address
6136 PETERS CREEK RD, ROANOKE, VA 24019-4028
(540) 283-3660
(540) 283-3677
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110-004821
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194113464
—
VA
Enumeration date
01/08/2015
Last updated
01/31/2022
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