Individual
CLARK A DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
36912
WI
2086S0129X
Vascular Surgery Physician
36912
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34344900
—
WI
Enumeration date
06/17/2005
Last updated
03/14/2023
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