Individual
BISHOD Q CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10080 HILLVIEW DR APT 153-D, PENSACOLA, FL 32514-5499
(850) 501-5002
Mailing address
10080 HILLVIEW DR APT 153-D, PENSACOLA, FL 32514-5499
(850) 501-5002
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/12/2020
Last updated
02/12/2020
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