Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME111874 | FL |
N | 208600000X | Surgeon | ME111874 | FL |
Y | 2086S0102X | Surgical Critical Care | ME111874 | FL |
N | 2086S0105X | Surgery of the Hand | ME111874 | FL |
N | 2086S0127X | Trauma Surgeon | ME111874 | FL |
NPI | 1649421132 |
---|---|
Provider Name | Dr. Jason M Clark |
First Address | Ocala, FL 34471-3770 |
Second Address | Ocala, FL 34471-3770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 11/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007273600 | (05) | FL |