Individual
GUY CLARK
Active
Individual
GUY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101047497
VA
207R00000X
Internal Medicine Physician
Primary
MD20063
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010256267
—
VA
05
—
64666985
—
KY
01
—
P00255508
MEDICARE RAILROAD
VA
05
—
Q064419
—
TN
Enumeration date
07/05/2006
Last updated
05/25/2021
Update your record
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