Individual
BRIAN MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
200 HAWKINS DR, DEPT. OF ORTHOPEDICS AND REHABILITATION, IOWA CITY, IA 52242-1009
(319) 467-5449
(319) 353-6754
Mailing address
200 HAWKINS DR, DEPT. OF ORTHOPEDICS AND REHABILITATION, IOWA CITY, IA 52242-1009
(319) 467-5449
(319) 353-6754
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
079191
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079191
DEPARTMENT OF PUBLIC HEALTH- STATE LICENSE
IA
Enumeration date
09/23/2015
Last updated
11/09/2015
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