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Dr. Edward Petersen Clack, DO
Family Medicine Physician in Dayton, Ohio
NPI 1659629053

Edward Petersen Clack is a Family Medicine Physician based in Dayton, OH. Edward Petersen Clack practices in Dayton, OH and has the professional credentials of DO. The NPI Number for Edward Petersen Clack is 1659629053 and holds a License No. 34.011463 (Ohio).

The current practice location address for Edward Petersen Clack is 5900 N Main St Ste 3, Dayton, OH and can be reached out via phone at 937-277-9371 and via fax at 937-277-7734.

Location: 5900 N Main St Ste 3, Dayton, OH, 45415-3198
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1659629053
Provider Name
Edward Petersen Clack
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
5900 N Main St Ste 3, Dayton, OH, 45415-3198
Phone Number
937-277-9371
Fax Number
937-277-7734
Provider Enumeration Date
08/16/2012
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0122811 05 OH
institution
Provider Business Practice Location Address Details
Address
5900 N Main St Ste 3
City
Dayton
State
Ohio
Zip
45415-3198
Phone Number
937-277-9371
Fax Number
937-277-7734
person
Provider Business Mailing Address Details
Address
5900 N Main St Ste 3
City
Dayton
State
Ohio
Zip
45415-3198
Phone Number
937-277-9371
Fax Number
937-277-7734
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
-
Taxonomy
207Q00000X
License No.
34.011463 (Ohio)
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
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