Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO 3277 | FL |
Y | 222Z00000X | Podiatrist | PO 3277 | FL |
N | 213EP1101X | Primary Podiatric Medicine | PO 3277 | FL |
NPI | 1306041173 |
---|---|
Provider Name | Dr. John F. Clarke |
First Address | Tampa, FL 33612-4745 |
Second Address | Tampa, FL 33612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 30/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340648200 | (05) | FL |
65962 | BLUE CROSS - FLORIDA (01) | FL |