Individual
WILLIAM BRUCE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
585 LEW LOUDON ROAD, LATHAM, NY 12110-5701
(518) 783-1472
(518) 783-1605
Mailing address
585 LEW LOUDON ROAD, LATHAM, NY 12110-5701
(518) 783-1472
(518) 783-1605
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
114221
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00798590
—
NY
Enumeration date
11/16/2006
Last updated
10/03/2011
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