Individual
JACK CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1528 DEL PRADO BLVD S, CAPE CORAL, FL 33990-3798
(239) 458-3338
(239) 458-0666
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774
(239) 599-2612
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
OS8284
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272380800
—
FL
Enumeration date
05/11/2006
Last updated
09/29/2021
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