Individual
MR. SAMUEL EDWARD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S.W.
Contact information
Practice address
17 SOUTH CENTRAL AV., IDABEL, OK 74745-4625
(580) 286-5184
(580) 286-5185
Mailing address
RR 2 BOX 849, BROKEN BOW, OK 74728-9685
(580) 584-2854
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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