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Individual
JEFFREY ALAN CLARK
Active
Individual
JEFFREY ALAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
3304
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0215665
—
IA
01
—
19423
WELLMARK INS PLAN
IA
01
—
421417307E4
JOHN DEERE HEALTH INS
IA
Enumeration date
05/19/2006
Last updated
02/04/2022
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