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Individual

MICHELLE CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
9040 JACKSON AVE, TACOMA, WA 98431-5001
(253) 968-3885
Mailing address
1 JARRETT WHITE RD, TRIPLER ARMY MEDICAL CENTER, TRIPLER ARMY MEDICAL CENTER, HI 96859-5001

Taxonomy

Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
DOS-1211
HI
208D00000X
General Practice Physician
DOS-1211
HI
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
02/24/2009
Last updated
01/06/2022
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