Individual
DR. EDWARD PETERSEN CLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5900 N MAIN ST STE 3, DAYTON, OH 45415-3198
(937) 277-9371
(937) 277-7734
Mailing address
5900 N MAIN ST STE 3, DAYTON, OH 45415-3198
(937) 277-9371
(937) 277-7734
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34.011463
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0122811
—
OH
Enumeration date
08/16/2012
Last updated
05/03/2023
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