Organization
GARY W. CLARK A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY W CLARK DPM (OWNER)
(435) 867-8521
Entity
Organization
Contact information
Practice address
55 N 400 E, BEAVER, UT 84713
(888) 437-3668
Mailing address
166 W 1325 N STE 300, CEDAR CITY, UT 84720-7854
(888) 437-3668
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
3207290501
UT
Other
Enumeration date
11/17/2006
Last updated
08/22/2020
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