Individual
DR. GARY BRUCE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1790 30TH ST, SUITE 230, BOULDER, CO 80301-1022
(303) 444-5131
(303) 444-5131
Mailing address
12541 GROVE ST, BROOMFIELD, CO 80020-5869
(720) 887-5726
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
20926
CO
Other
Enumeration date
12/27/2006
Last updated
07/08/2007
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