Organization
JOHN E. CLARK,M.D., LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN E. CLARK M.D. (OWNER)
(225) 766-2311
Entity
Organization
Contact information
Practice address
4545 BLUEBONNET BLVD, BATON ROUGE, LA 70809-5600
(225) 766-2311
(225) 767-7134
Mailing address
PO BOX 84358, BATON ROUGE, LA 70884-4358
(225) 766-2311
(225) 767-7134
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
08015R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1388483
—
LA
Enumeration date
02/20/2008
Last updated
09/09/2011
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