| Doctor Name: | DUSTIN E CLARK |
| NPI Number: | 1265562185 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 128 Scenega Valdez, AK - 99686 |
| Business Phone Number: | 9078353274 |
| Business Fax Number: | 9078353512 |
| Mailing Address: | Po Box 1013, VALDEZ |
| State: | AK |
| Postal Code: | 99686 |
| Phone Number: | 9072004995 |
| Fax Number: | |
| NPI Enumeration Date: | 03/07/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 172A00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Driver |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person employed to operate a motor vehicle as a carrier of persons or property. |