Individual
DR. RUSSELL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AUD
Contact information
Practice address
3101 E STATE ST STE 2108, EAGLE, ID 83616-6232
(208) 385-3480
(208) 385-3481
Mailing address
3101 E STATE ST STE 2108, EAGLE, ID 83616-6232
(208) 385-3480
(208) 385-3481
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AUD-1526
ID
Other
Enumeration date
04/10/2017
Last updated
03/01/2018
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