Individual
MR. JASON E CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4615 PHILIPS HIGHWAY, JACKSONVILLE, FL 32207-7265
(904) 739-7006
(904) 737-3412
Mailing address
4615 PHILIPS HIGHWAY, JACKSONVILLE, FL 32207-7265
(904) 739-7006
(904) 737-3412
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
005491100
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005491100
—
FL
Enumeration date
09/06/2012
Last updated
09/06/2012
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