| Doctor Name: | JACK CLARK |
| NPI Number: | 1073563847 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | OS8284 |
| Business Practice Address: | 1528 Del Prado Blvd S Cape Coral, FL - 339903798 |
| Business Phone Number: | 2394583338 |
| Business Fax Number: | 2399313454 |
| Mailing Address: | Po Box 7006, FT MYERS |
| State: | FL |
| Postal Code: | 339117006 |
| Phone Number: | 2399313440 |
| Fax Number: | |
| NPI Enumeration Date: | 05/11/2006 |
| NPI Last Update Date: | 06/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RR0500X |
| License Number: | OS8284 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Rheumatology |
| Taxonomy Definition: | An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |