Individual
GINA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1505 E MAIN ST, STIGLER, OK 74462-2913
(918) 967-3368
(918) 967-4582
Mailing address
PO BOX 179, STIGLER, OK 74462-0179
(918) 967-3368
(918) 967-4582
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
172613
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
5482
OK
Other
Enumeration date
08/26/2011
Last updated
11/01/2018
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