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Individual

DR. BROCK STEPHEN CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
2001 VAIL AVE, CHARLOTTE, NC 28207-1248
(704) 304-5000
Mailing address
813 E 37TH ST, CHARLOTTE, NC 28205-1116
(352) 361-1551

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2022-01455
NC
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
03/26/2019
Last updated
09/28/2022
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