Individual
MR. JOHN P CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
101 CAMELIA ST NW, ROYAL CITY, WA 99357
(509) 346-1447
(509) 346-1481
Mailing address
PO BOX 1028, 101 CAMELIA ST NW, ROYAL CITY, WA 99357
(509) 346-1447
(509) 346-1481
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10001599
WA
363AM0700X
Medical Physician Assistant
PA11682
CA
Other
Enumeration date
07/11/2006
Last updated
07/08/2007
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