Individual
AMANDA LOU CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5050 NE HOYT ST STE 255, PORTLAND, OR 97213-2982
(503) 231-0407
Mailing address
5050 NE HOYT ST STE 255, PORTLAND, OR 97213-2982
(503) 231-0407
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD13163
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114991
—
OR
Enumeration date
08/03/2006
Last updated
02/04/2022
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