Individual
DR. JASON CRAIG CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
520 VALLEY VIEW DR, MOLINE, IL 61265-6194
(309) 762-3621
(309) 762-3690
Mailing address
520 VALLEY VIEW DR, MOLINE, IL 61265-6194
(309) 762-3621
(309) 762-3690
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036125628
IL
207X00000X
Orthopaedic Surgery Physician
38994
IA
207X00000X
Orthopaedic Surgery Physician
TRN7762
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036125628
—
IL
Enumeration date
11/01/2006
Last updated
12/06/2010
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