Doctor Name: | JUSTIN A CLARK |
NPI Number: | 1922333970 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | AA |
License Number: | 67.000156 |
Business Practice Address: | 2139 Auburn Ave Cincinnati, OH - 452192906 |
Business Phone Number: | 5135852000 |
Business Fax Number: | |
Mailing Address: | 255 West Michigan Ave,, Jackson MICHIGAN |
State: | MI |
Postal Code: | 492041123 |
Phone Number: | 5177876440 |
Fax Number: | |
NPI Enumeration Date: | 10/08/2009 |
NPI Last Update Date: | 10/08/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 367H00000X |
License Number: | 67.000156 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Anesthesiologist Assistant |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist. |