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Individual

DR. BRENT A CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
1062 E RIVERSIDE DR STE 102, ST GEORGE, UT 84790-4454
(509) 301-1565
(509) 414-6455
Mailing address
2918 W LESINA HEIGHTS DR, ST GEORGE, UT 84770-1474
(509) 301-1565
(509) 414-6455

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
PO00000693
WA
213ES0103X
Foot & Ankle Surgery Podiatrist
02101
NV
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
135349530501
UT
213ES0103X
Foot & Ankle Surgery Podiatrist
PO00000693
WA

Other

Enumeration date
02/15/2006
Last updated
12/12/2024
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