Individual provider · Type 1 NPI

Michael Dwayne Clark

Driver · Lake Charles, LA

NPI number 1063683597 Active

Practice location

619 Clarence St Apt 5
Lake Charles, LA 70601-5370

Call (337) 721-8070 Map

Fax (337) 721-8060

Specialties and licenses

TaxonomyCodeLicense
Driver Primary 172A00000XNone listed

Driver: A person employed to operate a motor vehicle as a carrier of persons or property.

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About NPI 1063683597

Michael Dwayne Clark's National Provider Identifier is 1063683597, issued on Mar 12, 2008. The primary taxonomy on file is Driver (172A00000X), and the practice location is in Lake Charles, LA. The record was last updated on Mar 12, 2008.