Individual
DR. HENRY VONDELL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-9361
(253) 968-2252
Mailing address
MADIGAN ARMY MEDICAL CENTER, 9040 JACKSON AVE., TACOMA, WA 98431
(253) 968-2252
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9800216
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11521
BCBS PROVIDER NUMBER
NC
05
—
1790898450
—
NC
01
—
9800216
LICENSE - NC
NC
Enumeration date
08/16/2006
Last updated
03/07/2023
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