Individual
MR. MICHAEL DAVID CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
1305 HILL ST SE, ALBANY, OR 97322-6711
(541) 990-6946
Mailing address
1305 HILL ST SE, ALBANY, OR 97322-6711
(541) 990-6946
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
24-CRM-3907
OR
Other
Enumeration date
12/11/2024
Last updated
12/11/2024
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