MR. JOHN RILEY CLARK PA-C
NPI 1063072973
Physician Assistant - Medical in Oswego, IL
Active since June 13, 2019
About Mr. John Riley Clark Pa-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. JOHN RILEY CLARK PA-C (NPI 1063072973) is an individual medical provider in Oswego, Illinois, licensed in Illinois (085.007136) and active in the NPI registry since June 2019.
NPPES Registry Identity
NPI1063072973
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameMR. JOHN RILEY CLARKCredential: PA-C
Location Address2700 LIGHT RD APT 102Oswego, IL 60543-9231
Mailing Address2700 Light Rd Apt 102Oswego, IL 60543-9231 · (415) 516-8668
Phone(415) 516-8668
Sole ProprietorYes
Enumeration DateJune 13, 2019
Last NPPES UpdateAugust 2, 20192 updates tracked since enumeration
✔ NPI 1063072973 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in IL · 085.007136
2700 LIGHT RD APT 102, Oswego, IL 60543
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1063072973, enumerated as an "individual" on June 13, 2019.
The provider is located at 2700 LIGHT RD APT 102 OSWEGO, IL 60543 and the phone number is (415) 516-8668.
Physician Assistant with taxonomy code 363AM0700X and a focus in Medical.
