Wysong, Clark B
Wysong, Clark B is an individual health care provider with primary practice located at 19875 N 51St Ave , Glendale AZ 85308-5114. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wysong, Clark B can be contacted via phone (623) 581-8998.Contact Information
Primary practice address
19875 N 51St Ave
Glendale AZ 85308-5114
Phone: (623) 581-8998
Fax: (623) 581-6461
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 25168 | Arizona |
Profile Details
| NPI number | 1861469165 |
|---|---|
| LBN Legal business name | Wysong, Clark B |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 6th, 2006 |
| Last updated | Jan 10th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861469165 | NPPES |
| Arizona | MEDICAID | 385527 |
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