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1770871113
BENJAMIN CLARK
PORTLAND, OR
NPI
1770871113
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
224P00000X Prosthetist
Additional Taxonomies
222Z00000X Orthotist
Enumeration Date
2011-07-19
Last Update Date
2018-03-01
Business Address
BENJAMIN CLARK CPO
17316 NE HALSEY ST
PORTLAND, OR 97230-6026
Phone number: 503-257-6623
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Mailing Address
BENJAMIN CLARK CPO
17316 NE HALSEY ST
PORTLAND, OR 97230-6026
Phone number: 503-257-6623
Copy
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