Individual
TERRY L CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
728 PENNSYLVANIA AVE, SHEBOYGAN, WI 53081-4669
(920) 803-8014
(920) 803-8015
Mailing address
PO BOX 1127, SHEBOYGAN, WI 53082-1127
(920) 457-6750
(920) 457-8350
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
105334-0501
UT
213E00000X
Podiatrist
Primary
649-025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43213700
—
WI
Enumeration date
03/24/2006
Last updated
07/09/2007
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