Individual
CLARK REED STREAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
120 N RICHARD JACKSON BLVD STE 140, PANAMA CITY BEACH, FL 32407-2522
(850) 532-6168
(850) 532-6568
Mailing address
120 N RICHARD JACKSON BLVD STE 140, PANAMA CITY BEACH, FL 32407-2522
(505) 326-1688
(505) 326-5688
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9100951
FL
363AM0700X
Medical Physician Assistant
PA9100951
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290567101
—
FL
Enumeration date
06/21/2006
Last updated
06/03/2022
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