Individual
RICK G CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1394 W 16TH ST, YUMA, AZ 85364-4430
(928) 539-0055
(928) 539-0053
Mailing address
PO BOX 3, YUMA, AZ 85366-0003
(928) 539-0055
(928) 539-0055
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3448
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
930421
—
AZ
Enumeration date
10/10/2006
Last updated
02/19/2008
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