Individual
MR. JAC A CLEMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
820 ARBUTUS AVE, OCONTO, WI 54153-2004
(920) 835-1100
(920) 835-1099
Mailing address
PO BOX 1866, GREEN BAY, WI 54305-1866
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-001577
IL
363A00000X
Physician Assistant
Primary
603-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42940500
—
WI
Enumeration date
08/07/2006
Last updated
11/18/2014
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