Healthcare Provider Details

I. General information

NPI: 1588308258
Provider Name (Legal Business Name): CLARK DELONA PAGE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE RM 4402
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

1501 N CAMPBELL AVE RM 4402
TUCSON AZ
85724-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-6670
  • Fax: 520-626-4008
Mailing address:
  • Phone: 520-626-6670
  • Fax: 520-626-4008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7708-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11688
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15731
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: