Individual
JIMMY CLARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A. - C
Contact information
Practice address
5512 SPRING TIDE WAY, MADISON, WI 53718-9125
(224) 848-0612
Mailing address
5512 SPRING TIDE WAY, MADISON, WI 53718-9125
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3614
WI
Other
Enumeration date
09/15/2015
Last updated
06/09/2026
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