Individual
RICHARD KENNETH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1630 CHIPPEWA DR, RHINELANDER, WI 54501-9503
(715) 361-5480
Mailing address
PO BOX 646, WOODRUFF, WI 54568-0646
(715) 614-0038
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3766-23
WI
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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