NPI 1619650439

William Clark

Practitioner Military Health Care Provider Fort Leonard Wood, MO

Practice location

Address: 4430 Missouri Ave, Fort Leonard Wood, MO 65473-9098
Phone: (703) 309-5012

Registered specialties

Military Health Care Provider Primary

Other Service Providers Taxonomy 171000000X

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Registry record

NPI: 1619650439
Entity type: Individual
Sex (as registered): Male
NPI issued: 9 Aug 2023
Record last updated: 9 Aug 2023

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.