Individual
MR. GEOFFREY WAYNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
7325 SW CHILDS RD, PORTLAND, OR 97224-7713
(503) 797-9812
(503) 797-9996
Mailing address
7325 SW CHILDS RD, PORTLAND, OR 97224-7713
(503) 797-9812
(503) 797-9996
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-908663
OR
Other
Enumeration date
02/28/2006
Last updated
07/08/2007
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