Clark, Jack

Clark, Jack is an individual health care provider with primary practice located at 1528 Del Prado Blvd S , Cape Coral FL 33990-3798. He recently has only one registered license in Allopathic & Osteopathic Physicians / Rheumatology, which is considered as his primary health care specialty. Clark, Jack can be contacted via phone (239) 458-3338.

Contact Information

Primary practice address
1528 Del Prado Blvd S Cape Coral FL 33990-3798
Phone: (239) 458-3338
Fax: (239) 458-0666
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Rheumatology 207RR0500X OS8284 Florida

Profile Details

NPI number 1073563847
LBN Legal business name Clark, Jack
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2006
Last updated Sep 29th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073563847 NPPES
Florida MEDICAID 272380800

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