Individual
GARRY ANDREW CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3930 STADIUM DR, SIOUX CITY, IA 51106-5166
(712) 276-4325
(712) 276-6033
Mailing address
3930 STADIUM DR, SIOUX CITY, IA 51106-5166
(712) 276-4325
(712) 276-6033
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
01361
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080082594
MEDICARE RAILROAD INDIVIDUAL NUMBER
IA
01
—
1528001492
ST LUKES GROUP NPI
IA
01
—
21964
ST LUKES GROUP PTAN
IA
01
—
21964001
ST LUKES INDIVIDUAL PTAN
IA
01
—
CG1061
MEDICARE RAILROAD GROUP NUMBER
IA
Enumeration date
01/11/2006
Last updated
01/26/2012
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