Male or Other

Gary L. Clark PA C

Medical Physician Assistant in Brooksville, FL(View on Map)

Full Name

Gary L Clark PA C

NPI Number

1114911328

NPI Type

Individual Provider

Gender

Male

Enumeration Date

09/01/2005

Specialties

(Taxonomies)

Code

363AM0700X

Primary Taxonomy

Yes

Licenses

State

Florida

License Number

PA2265

Contact
Information

Purpose

Mailing
Location

Address

605 LAMAR AVE
605 LAMAR AVE

City

Brooksville
Brooksville

State

FL
FL

Postal Code

34601-3211
34601-3211

Country

US
US

Telephone Number

(352) 799-5411
(352) 799-5411

Identifiers

Identifier

900013195
970029323
Y00ZL
290338500
970028329

Identifier State

FL
FL
FL
FL
FL

Identifier Issuer

RAILROAD MEDICARE
RAILROAD MEDICARE
BC/BS FL
Unknown
RAILROAD MEDICARE

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 09/22/2014

Provider Address

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