Provider Demographics
NPI:1609993443
Name:CLARK, ARTHUR LEN (CPLP)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:LEN
Last Name:CLARK
Suffix:
Gender:M
Credentials:CPLP
Other - Prefix:MR
Other - First Name:ARTHUR
Other - Middle Name:LEN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPLP
Mailing Address - Street 1:9547 HUEBNER RD
Mailing Address - Street 2:SUITE2
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1510
Mailing Address - Country:US
Mailing Address - Phone:210-694-4942
Mailing Address - Fax:
Practice Address - Street 1:9547 HUEBNER RD
Practice Address - Street 2:SUITE2
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1510
Practice Address - Country:US
Practice Address - Phone:210-694-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL.P. 598174400000X
TX5981744P3200X
TXPROSTHETIST #5981744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered1744P3200XOther Service ProvidersSpecialistProsthetics Case Management