| Doctor Name: | TYLER JOHN CLARK |
| NPI Number: | 1639492523 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | R.D |
| License Number: | 3061 |
| Business Practice Address: | 940 Belmont St Food And Nutrition Services Brockton, MA - 023015596 |
| Business Phone Number: | 7748261439 |
| Business Fax Number: | |
| Mailing Address: | 940 Belmont St, Food And Nutrition Services BROCKTON |
| State: | MA |
| Postal Code: | 023015596 |
| Phone Number: | 7748261439 |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2010 |
| NPI Last Update Date: | 05/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 3061 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |