Individual
JESSE LAWTON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5767 W CENTURY BLVD, SUITE 200, LOS ANGELES, CA 90045-5632
(310) 301-8708
Mailing address
200 MEDICAL PLAZA, SUITE 365, LOS ANGELES, CA 90024-0000
(310) 301-8708
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A95103
CA
207RI0200X
Infectious Disease Physician
Primary
A95103
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A951030
—
CA
Enumeration date
02/27/2008
Last updated
11/07/2008
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