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Individual
MR. SAMUEL JASON CLARK
Active
Individual
MR. SAMUEL JASON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-11081
NC
363A00000X
Physician Assistant
Primary
5174
SC
Other
Enumeration date
09/06/2012
Last updated
12/04/2025
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