Most Relevant Information
Provider Data
| NPI Number: | 1003420415 |
| Provider Name: | ROBERT SAMUEL CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/02/2020 |
| Last Updated: | 09/02/2020 |
Provider Practice Location
4460 S HIGHLAND DR STE 210
SALT LAKE CITY
UT
841243550
Practice Location Phone/Fax
| Phone: | 8889494864 |
| Fax: |
Provider Mailing Location
4460 S HIGHLAND DR STE 210
SALT LAKE CITY
UT
841243550
Provider Mailing Phone/Fax
| Phone: | 8889494864 |
| Fax: |