Individual
DUSTIN MICHAEL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1420 TUSCULUM BLVD, LAUGHLIN MEMORIAL HOSPITAL, GREENEVILLE, TN 37745
(423) 787-5000
Mailing address
900 MELROSE CIR, JOHNSON CITY, TN 37601-2114
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
50872
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39020000X
RESIDENT IN TRAINING
TX
Enumeration date
06/29/2007
Last updated
07/31/2017
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