Individual
ED J CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2600 SIXTH STREET SW, OHIO HOSPITAL BASED PHYSICIAN CORP, CANTON, OH 44710
(330) 363-7462
(330) 363-7679
Mailing address
2600 SIXTH STREET SW, OHIO HOSPITAL BASED PHYSICIAN CORP, CANTON, OH 44710
(330) 363-7462
(330) 363-7679
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN217418
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0886760
—
OH
Enumeration date
04/17/2006
Last updated
10/31/2007
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