Individual
EDWARD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
595 W LAKE MEAD PKWY, HENDERSON, NV 89015-7015
(702) 565-1007
(702) 565-0836
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11309
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1005063739
—
NV
05
—
100506374
—
NV
01
—
11309
NV LICENSE
NV
05
—
1356318174
—
NV
Enumeration date
03/01/2006
Last updated
10/17/2022
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