Clark Anderson, PA-C
Physician Assistant in Peoria, IL. Individual provider (NPI-1).
NPI number1750460481
StatusActive
Last updated in NPPESDec 10, 2014
Details
- NPI
- 1750460481
- Entity type
- Individual (NPI-1)
- Name
- Clark Anderson
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 3, 2006
- Last updated
- Dec 10, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 085-002809 | IL | Yes |
Practice location
1001 Main StSuite 500a
Peoria, IL 61606-1907
Phone 309-672-4980 · Fax 309-671-2979
Mailing address
Po Box 365Morton, IL 61550-0365
Phone 309-672-4980 · Fax 309-671-2979
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