Individual
CLARK J LESLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1230 CLARK ST APT B, CAMBRIDGE, OH 43725-9807
(740) 432-5685
(740) 432-3812
Mailing address
PO BOX 7527, DUBLIN, OH 43017-0727
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35072500
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2023330
—
OH
Enumeration date
10/19/2006
Last updated
10/17/2024
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