Individual
PAVEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
31 BLUFF RIDGE DR UNIT 1B, LAKE OZARK, MO 65049-6343
(618) 663-1028
Mailing address
31 BLUFF RIDGE DR UNIT 1B, LAKE OZARK, MO 65049-6343
(618) 663-1028
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/18/2025
Last updated
12/18/2025
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