Individual
THOMAS CLARK
Active
Individual
THOMAS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0000159
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970011935
RAILROAD MEDICARE
MD
Enumeration date
06/14/2006
Last updated
05/09/2013
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