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Individual

TYLER M. CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
165 S UNION BLVD STE 800, LAKEWOOD, CO 80228-2213
(303) 988-2680
(303) 896-8057
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3203

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0005701
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9000170986
CO
Enumeration date
02/07/2019
Last updated
04/17/2026
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