Organization
JESSICA L CLARK MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAUN D SKYRM (ADMINISTRATOR)
(330) 256-0533
Entity
Organization
Contact information
Practice address
600 GRAND PANAMA BLVD, PANAMA CITY BEACH, FL 32407-3459
(233) 767-4850
(330) 595-4727
Mailing address
6605 BUTTON BUCK TRL, PANAMA CITY BEACH, FL 32413-9577
(330) 256-0533
(330) 595-4727
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
NONE YET
—
Enumeration date
08/22/2022
Last updated
08/22/2022
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