Individual
SHANE B CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2310 VILLAGE SQUARE PKWY STE 106C, FLEMING ISLAND, FL 32003-6409
(904) 202-7300
(904) 202-2754
Mailing address
PO BOX 746654, ATLANTA, GA 30374-6654
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
OS21375
FL
207RH0003X
Hematology & Oncology Physician
Primary
OS21375
FL
207RX0202X
Medical Oncology Physician
OS21375
FL
Other
Enumeration date
06/27/2018
Last updated
04/30/2025
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