Individual
ANDREW ROBERT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5123 4TH AVENUE CIR E, BRADENTON, FL 34208-5620
(941) 744-5510
(941) 744-5166
Mailing address
5123 4TH AVENUE CIR E, BRADENTON, FL 34208-5620
(941) 744-5510
(941) 744-5166
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS9370
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272670000
—
FL
01
—
28803
BLUE CROSS
FL
Enumeration date
11/09/2005
Last updated
05/15/2014
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