Individual
TIMOTHY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
1200 VESTER AVE, SPRINGFIELD, OH 45503-1304
(937) 828-2051
(937) 828-2052
Mailing address
1430 OAK CT STE 100, BEAVERCREEK, OH 45430-1064
(937) 404-1101
(937) 404-1210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.007543RX
OH
Other
Enumeration date
05/06/2006
Last updated
05/02/2025
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