Individual
JONATHAN CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 E WOODHURST DR, SUITE Q-200, SPRINGFIELD, MO 65804-4257
(417) 881-5639
(417) 881-5664
Mailing address
1200 E WOODHURST DR, SUITE Q-200, SPRINGFIELD, MO 65804-4257
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD101561
MO
Other
Enumeration date
08/24/2005
Last updated
07/08/2007
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