Individual
DR. JOHN D CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1340 S 18TH ST STE 104, FERNANDINA BEACH, FL 32034-4733
(904) 277-3311
(904) 277-3343
Mailing address
PO BOX 746649, ATLANTA, GA 30374-6649
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
04-23864
KS
2084N0400X
Neurology Physician
Primary
ME169258
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200300630A
—
KS
Enumeration date
06/27/2006
Last updated
08/02/2024
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