Individual
BENJAMIN T CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1840 S STAPLEY DR STE 101, MESA, AZ 85204-6682
(480) 464-6979
(480) 464-6910
Mailing address
25500 N NORTERRA DR, PHOENIX, AZ 85085-8200
(623) 277-1130
(866) 837-6575
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
006841
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/24/2010
Last updated
12/01/2021
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