Individual
DR. RANDIL L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
980 IRONWOOD DR W, STE 104, COEUR D' ALENE, ID 83814
(208) 667-0621
(208) 664-1709
Mailing address
980 IRONWOOD DR W, STE 104, COEUR D' ALENE, ID 83814
(208) 667-0621
(208) 664-1709
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
M-5699
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002667200
—
ID
Enumeration date
02/22/2007
Last updated
05/25/2012
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