Doctor Name: | JOHN LEON CLARK |
NPI Number: | 1134382377 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | PO2985 |
Business Practice Address: | 542067 Us Highway 1 Callahan, FL - 320118110 |
Business Phone Number: | 9048792552 |
Business Fax Number: | 9048796360 |
Mailing Address: | Po Box 1578, CALLAHAN |
State: | FL |
Postal Code: | 320111578 |
Phone Number: | 9048792552 |
Fax Number: | 9048796360 |
NPI Enumeration Date: | 07/08/2008 |
NPI Last Update Date: | 07/08/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | PO2985 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |