Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 202923 | LA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 202923 | LA |
NPI | 1225220551 |
---|---|
Provider Name | Wesley Allen Clark |
First Address | Marrero, LA 70072-3112 |
Second Address | Marrero, LA 70072-3112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 28/09/2015 |