Provider Demographics
NPI:1043476245
Name:CLARKE, TROY ALAN (PA-C)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:ALAN
Last Name:CLARKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BROADWAY # 335F
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2314
Mailing Address - Country:US
Mailing Address - Phone:310-450-4622
Mailing Address - Fax:
Practice Address - Street 1:929 GEORGIA ST
Practice Address - Street 2:HEALTH CARE PARTNERS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1321
Practice Address - Country:US
Practice Address - Phone:213-861-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant