Individual
DR. BLISS WATSON CLARK II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1262 E NORTH ST, MANTECA, CA 95336-4962
(209) 214-7053
(209) 523-0764
Mailing address
1541 FLORIDA AVE, SUITE 200, MODESTO, CA 95350-4423
(209) 214-7053
(209) 523-0764
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
G59282
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033099502
—
TX
Enumeration date
07/14/2005
Last updated
11/05/2011
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