Individual
DR. RYAN STEWART CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1380 E STROOP RD, KETTERING, OH 45429-4926
(937) 293-3486
(937) 293-3605
Mailing address
1103 FAIRINGTON DR, SIDNEY, OH 45365-8130
(937) 980-7400
(937) 980-7441
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
34010728
OH
207RC0000X
Cardiovascular Disease Physician
Primary
34010728
OH
390200000X
Student in an Organized Health Care Education/Training Program
58.003689
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100097
—
OH
Enumeration date
01/10/2011
Last updated
01/28/2021
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