Individual
MAX A CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1975 MIAMISBURG CENTERVILLE RD, SUITE A, CENTERVILLE, OH 45459-3811
(937) 438-1340
(937) 438-4802
Mailing address
1975 MIAMISBURG CENTERVILLE RD, SUITE A, CENTERVILLE, OH 45459-3811
(937) 438-1340
(937) 438-4802
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
34003865
OH
207VX0201X
Gynecologic Oncology Physician
34003865
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0803367
—
OH
Enumeration date
08/24/2005
Last updated
09/11/2025
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