Individual
BETH E CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2500 S HAVANA ST, AURORA, CO 80014-1618
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
900
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07009004
—
CO
01
—
P00368635
RR MEDICARE
CO
Enumeration date
10/25/2005
Last updated
06/06/2022
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