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Individual

DR. TED ROBERT CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D., M.P.P.

Contact information

Practice address
701 N. 1ST STREET, SPRINGFIELD, IL 62781
(217) 545-7409
(217) 545-2711
Mailing address
PO BOX 19638, SPRINGFIELD, IL 62794-9638
(217) 545-7409
(217) 545-2711

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01064079A
IN

Other

Enumeration date
06/03/2008
Last updated
03/14/2013
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