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General NPI Number Information
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NPI Number | 1831061860
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Entity Type | Individual
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Provider Name | WILL CLARK
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Gender | Male
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1205 E BROADWAY ST
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City | MISSOULA
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State | MT
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Zip | 59802-4968
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Country | US
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Telephone | 406-243-7811
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Fax |
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Provider Business Mailing Address
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Address Line | 72 SUSIE TABOR RD
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City | SCOTTSVILLE
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State | KY
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Zip | 42164-9425
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Country | US
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Telephone | 270-619-1398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | E3919822
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License Number State | MT
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