Provider Demographics
NPI:1194742643
Name:CLARK, BRYAN D (DO)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:D
Last Name:CLARK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2250 CASTLEBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4009
Mailing Address - Country:US
Mailing Address - Phone:804-513-7550
Mailing Address - Fax:804-379-7506
Practice Address - Street 1:2400 LEE HWY N
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-2326
Practice Address - Country:US
Practice Address - Phone:540-994-8100
Practice Address - Fax:804-379-7506
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-12-03
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Provider Licenses
StateLicense IDTaxonomies
VA0102201448207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist