Individual
GREGORY P CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
777 AVENUE H, POWELL VALLEY HEALTHCARE INC, POWELL, WY 82435
(307) 754-3405
(307) 754-1207
Mailing address
777 AVENUE H, POWELL, WY 82435
(307) 754-3405
(307) 754-1207
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
203
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115812100
—
WY
Enumeration date
10/31/2005
Last updated
05/13/2015
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