Individual
DR. JOHN E CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
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
174400000X
Specialist
Primary
08015R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1388483
—
LA
Enumeration date
02/12/2007
Last updated
05/18/2009
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