Individual
DR. LEROY A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
100 LAKE TRAVERSE DR, SISSETON, SD 57262-7046
(605) 698-7606
(605) 742-0812
Mailing address
100 LAKE TRAVERSE DR, SISSETON, SD 57262-7046
(605) 698-7606
(605) 742-0182
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5019
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5549050
—
SD
Enumeration date
04/12/2006
Last updated
09/05/2012
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