Doctor Name: | DR. RYAN STEWART CLARK |
NPI Number: | 1396049011 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 58.003689 |
Business Practice Address: | 1380 E Stroop Rd Kettering, OH - 454294926 |
Business Phone Number: | 9372933486 |
Business Fax Number: | 9372933605 |
Mailing Address: | 1380 E Stroop Rd, KETTERING |
State: | OH |
Postal Code: | 454294926 |
Phone Number: | 9372933486 |
Fax Number: | 9372933605 |
NPI Enumeration Date: | 01/10/2011 |
NPI Last Update Date: | 06/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 58.003689 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |