MEDICARE: MR. CLARK DELONA PAGE P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	7708-23	WI
2	363A00000X	Physician Assistant	11688	AZ
3	363AM0700X	Medical Physician Assistant	PA15731	TX

General Provider Information

NPI Number	:	1588308258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLARK DELONA PAGE P.A.

Provider Business Mailing Address
First Line	:	1501 N CAMPBELL AVE RM 4402
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-0001
Country	:	US
Telephone Number	:	520-626-6670
Fax Number	:	520-626-4008

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVE RM 4402
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-0001
Country	:	US
Telephone Number	:	520-626-6670
Fax Number	:	520-626-4008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	05/08/2026

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Directions to “ MR. CLARK DELONA PAGE P.A.” Practice Location

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