Individual
JACOB CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-2000
Mailing address
4537 TUNDRA LN, MCFARLAND, WI 53558-9158
(605) 521-8056
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
02/08/2023
Last updated
04/07/2023
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