Individual
LARRY EDWARD CLARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
121 NATIONWIDE DR, SUITE A, LYNCHBURG, VA 24502-4272
(434) 384-1862
(434) 384-7704
Mailing address
121 NATIONWIDE DR, SUITE A, LYNCHBURG, VA 24502-4272
(434) 384-1862
(434) 384-7704
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
0101231402
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010149002
—
VA
Enumeration date
02/23/2006
Last updated
07/16/2010
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