Clark, Jason Craig

Clark, Jason Craig is an sole proprietor health care provider with primary practice located at 520 Valley View Dr , Moline IL 61265-6194. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Clark, Jason Craig can be contacted via phone (309) 762-3621.

Contact Information

Primary practice address
520 Valley View Dr Moline IL 61265-6194
Phone: (309) 762-3621
Fax: (309) 762-3690
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X TRN7762 Florida
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 38994 Iowa
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 036125628 Illinois

Profile Details

NPI number 1811075856
LBN Legal business name Clark, Jason Craig
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 1st, 2006
Last updated Dec 6th, 2010 - about 15 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 1811075856 NPPES
Illinois MEDICAID 036125628

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