NPI 1063683597

Michael Dwayne Clark

Practitioner Driver Lake Charles, LA

Practice location

Address: 619 Clarence St APT 5, Lake Charles, LA 70601-5370
Phone: (337) 721-8070
Fax: (337) 721-8060

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X

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Registry record

NPI: 1063683597
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 Mar 2008
Record last updated: 12 Mar 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.