Individual
JASON D CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
239 COLONNADE BLVD STE 2, STATE COLLEGE, PA 16803-2668
(582) 220-2310
(582) 220-2311
Mailing address
239 COLONNADE BLVD STE 2, STATE COLLEGE, PA 16803-2668
(582) 220-2310
(582) 220-2311
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
071601
GA
207X00000X
Orthopaedic Surgery Physician
2015-00059
NC
207X00000X
Orthopaedic Surgery Physician
58.003143
OH
207X00000X
Orthopaedic Surgery Physician
Primary
OS018039
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1031367111
—
PA
Enumeration date
05/25/2010
Last updated
07/03/2024
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