Individual
CHARLES S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
BLDG. H 2005 KNIGHT LANE ATTN: MEDICAL STAFF SERVICES, NAVY MEDICINE SUPPORT COMMAND, JACKSONVILLE, FL 92055-0140
(858) 361-9254
Mailing address
3986 SHIELDS ST, SAN DIEGO, CA 92124-3314
(858) 361-9254
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
12/23/2009
Last updated
12/23/2009
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