| NPI | 1629140173 |
|---|---|
| Doing Business As | GARY W CLARK DPM A PROFESSIONAL CORP |
| Entity Type | Organization |
| Authorized Contact | GARY W CLARK Owner 435-867-8521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 320729-0501) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: UT 3207290501) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2008-02-22 |