| Nicholas Clark, | |
|
4430 Missouri Ave, Fort Leonard Wood, MO 65473-9098 | |
| (800) 874-2273 | |
| Not Available |
| Full Name | Nicholas Clark |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 4430 Missouri Ave, Fort Leonard Wood, Missouri |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740816842 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 0102207074 (Virginia) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Nicholas Clark, 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX 78234-4504 Ph: (210) 220-7638 | Nicholas Clark, 4430 Missouri Ave, Fort Leonard Wood, MO 65473-9098 Ph: (800) 874-2273 |
Andrea Stephenson, Pediatrics Medicare: Medicare Enrolled Practice Location: 4430 Missouri Ave, Fort Leonard Wood, MO 65473 Phone: 808-735-9617 | |
Egberto Toro, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 126 Missouri Ave, Attn: Mcxp-ccs-cr (credentials), Fort Leonard Wood, MO 65473 Phone: 573-596-0417 Fax: 573-596-0524 | |
Dr. Elena A Rostapshova, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 126 Missouri Ave, Mcxp-ccs-cr, Fort Leonard Wood, MO 65473 Phone: 573-596-0417 Fax: 573-596-0524 | |
Erica Marie Grimm, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 4430 Missouri Ave, Fort Leonard Wood, MO 65473 Phone: 573-596-1766 | |
Dr. Roman Oleh Bilynsky, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 126 Missouri Avenue, Glwach - Attn: Credentials Office, Fort Leonard Wood, MO 65473 Phone: 573-596-0415 Fax: 573-596-0524 | |
Dr. Thomas E Ellwood, M.D Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 126 Missouri Ave, Mcxp-ccs-cr, Fort Leonard Wood, MO 65473 Phone: 573-596-0417 Fax: 573-596-0524 |