Individual
LAURENCE J CLARK
Active
Individual
LAURENCE J CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101030440
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
065941
ANTHEM HEALTHKEEPERS
VA
01
—
409113518
PALMETTO MEDICARE RAILROAD
DC
05
—
6086659
—
VA
Enumeration date
11/30/2005
Last updated
12/01/2009
Update your record
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