Clark, Gary L

Clark, Gary L is an individual health care provider with primary practice located at 605 Lamar Ave , Brooksville FL 34601-3211. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Clark, Gary L can be contacted via phone (352) 799-5411.

Contact Information

Primary practice address
605 Lamar Ave Brooksville FL 34601-3211
Phone: (352) 799-5411
Fax: (352) 544-2713
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA2265 Florida

Profile Details

NPI number 1114911328
LBN Legal business name Clark, Gary L
Credentials PA C
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 1st, 2005
Last updated Sep 22nd, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114911328 NPPES
Florida Other 900013195 RAILROAD MEDICARE
Florida Other 970029323 RAILROAD MEDICARE
Florida Other Y00ZL RAILROAD MEDICARE
Florida MEDICAID 290338500 RAILROAD MEDICARE
Florida Other 970028329 RAILROAD MEDICARE

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