Healthcare Provider Details

I. General information

NPI: 1558029686
Provider Name (Legal Business Name): TONY RAMON CLARKE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 GEARY BLVD
SAN FRANCISCO CA
94115-3358
US

IV. Provider business mailing address

2425 GEARY BLVD
SAN FRANCISCO CA
94115-3358
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-3304
  • Fax:
Mailing address:
  • Phone: 415-833-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9766
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number68369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: