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Organization

GARY W. CLARK INC

Active
Other names
Gary W Clark DPM A Professional Corp
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GARY W CLARK DPM (OWNER)
(435) 867-8521
Entity
Organization

Contact information

Practice address
166 W 1325 N, SUITE 300, CEDAR CITY, UT 84720-7792
(435) 867-8521
Mailing address
PO BOX 1986, CEDAR CITY, UT 84721-1986
(435) 867-8521

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
320729-0501
UT
332BC3200X
Customized Equipment (DME)
3207290501
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
529212733004
UT
Enumeration date
11/13/2006
Last updated
02/22/2008
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