Individual
MR. JUSTIN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
645 E MISSOURI AVE STE 300, PHOENIX, AZ 85012-1351
(480) 500-2545
Mailing address
330 E ROOSEVELT ST APT 3025, PHOENIX, AZ 85004-4306
(260) 312-7090
(602) 603-5322
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9159
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9159
ARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS
AZ
Enumeration date
10/08/2020
Last updated
06/25/2026
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