Individual
BRIAN D. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
601 N FRIO ST, SAN ANTONIO, TX 78207-3011
(210) 261-3750
(210) 444-1474
Mailing address
3031 W IH 10, SAN ANTONIO, TX 78201-5159
(210) 261-1000
(210) 731-8678
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA04747
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA04747
ST. LICENSE
TX
Enumeration date
06/13/2006
Last updated
07/21/2015
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