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Individual

LEO JP CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5705 MONCLOVA RD, SUITE 204, MAUMEE, OH 43537-1875
(419) 891-8045
(419) 891-8044
Mailing address
1 SEAGATE, SUITE 800, TOLEDO, OH 43604-1558
(567) 585-1983
(419) 824-7359

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
35039317C
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
318954
OH
Enumeration date
05/31/2005
Last updated
01/12/2016
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