Individual
JEFFREY M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1550 BOYSON RD, HIAWATHA, IA 52233-2362
(319) 743-7300
(319) 743-7311
Mailing address
1550 BOYSON RD, HIAWATHA, IA 52233-2362
(319) 743-7300
(319) 743-7311
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22720
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0289116
—
IA
Enumeration date
01/19/2006
Last updated
07/08/2007
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