Individual
JACK ALAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 W 17TH ST, TULSA, OK 74107-1886
(620) 704-6570
Mailing address
245 S 250TH ST, PITTSBURG, KS 66762-8531
(620) 704-6570
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/12/2025
Last updated
02/12/2025
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