Clark, Ryan William

Clark, Ryan William is an individual health care provider with primary practice located at 2845 Greenbrier Rd , Green Bay WI 54311-6519. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Interventional Pain Medicine is his primary health care specialty. Clark, Ryan William can be contacted via phone (920) 288-8377.

Contact Information

Primary practice address
2845 Greenbrier Rd Green Bay WI 54311-6519
Phone: (920) 288-8377
Fax: (920) 288-8385
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 67188 Wisconsin
Allopathic & Osteopathic Physicians / Pain Medicine 208VP0000X 67188 Wisconsin
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 67188 Wisconsin

Profile Details

NPI number 1720499759
LBN Legal business name Clark, Ryan William
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 13th, 2014
Last updated May 25th, 2023 - about 3 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 1720499759 NPPES
Wisconsin MEDICAID 100068648

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