Individual
DR. JAMES ELLIOTT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
475 OSCEOLA ST, SUITE 1200, ALTAMONTE SPRINGS, FL 32701-7857
(407) 339-9500
(407) 339-2266
Mailing address
475 OSCEOLA ST, SUITE 1200, ALTAMONTE SPRINGS, FL 32701-7857
(407) 339-9500
(407) 339-2266
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME 35769
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045664100
—
FL
01
—
07-00018
UHC PROVIDER ID#
FL
01
—
2153489
AETNA PROVIDER ID#
FL
01
—
47361
BC/BS PROVIDER ID#
FL
01
—
592438966
TAX IDENTIFICATION NUMBER
FL
Enumeration date
07/12/2006
Last updated
05/09/2008
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