JACK CLARK (NPI# 1073563847) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073563847 |
| Entity Type | Individual |
| Full Name | JACK CLARK |
| Credential | D.O. |
| Practice Address |
1528 Del Prado Blvd S Cape Coral FL 33990-3798 |
| Mailing Address |
3434 Hancock Bridge Pkwy Ste 301 North Fort Myers FL 33903-7099 |
| Practice Telephone | 2394583338 |
| Practice Fax Number | 2394580666 |
| Mailing Telephone | 8778563774 |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2019-02-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
OS8284 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 272380800 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083840342 | Jack R Clark | Dentist | 1856 Lancaster Rd, Homewood, AL 35209-4114 | 2009-06-01 |
| 1265571608 | Jack Douglas Clark | Ophthalmology | 7112 N Fresno St, Suite 100, Fresno, CA 93720-2940 | 2007-02-05 |
| 1346320140 | Jack Prow Clark | Family Medicine | 518 Ems D15 Ln, Syracuse, IN 46567-8026 | 2006-10-16 |
| 1306824016 | Jack Crowley Clark Sr. | Radiology | 1431 Centerpoint Blvd, Teamhealth Radiology Ste 100, Knoxville, TN 37932-1984 | 2006-01-03 |
| 1902881014 | Jack J Clark | Chiropractor | 6015 E State Blvd, Fort Wayne, IN 46815-7638 | 2005-12-12 |
| 1477799112 | Jack Clark | Counselor | 4411 N Cedar Ave, Fresno, CA 93726-2538 | 2008-12-31 |
| 1841311487 | Jack Malcolm Clark IIi | Social Worker | 7711 Madonna, San Antonio, TX 78216-6620 | 2007-04-02 |
| 1902992837 | Jack O. Clark | Internal Medicine | 450 E Main St, Rexburg, ID 83440 | 2006-10-05 |
| 1427092857 | Jack C Clark | Family Medicine | 103 Midlake Dr, Knoxville, TN 37918-3039 | 2006-06-15 |
| 1588616882 | Jack Lewis Clark | Oral & Maxillofacial Surgery | 21700 Northwestern Hwy, Suite 1290, Southfield, MI 48075-4906 | 2006-05-16 |
| Street Address |
1528 DEL PRADO BLVD S |
| City | CAPE CORAL |
| State | FL |
| Zip Code | 33990-3798 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538167838 | David Nelson Depree | Internal Medicine | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2005-07-11 |
| 1487180469 | Hannah Schrubbe | Family Medicine | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2017-05-11 |
| 1831549765 | Dawn Russi | Nurse Practitioner | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2016-06-22 |
| 1396156360 | William Arthur Farmer | Physician Assistant | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2014-05-13 |
| 1235567405 | Robin Garling | Physician Assistant | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2013-10-24 |
| 1861820235 | Murla Ecclesiaste | Nurse Practitioner | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2013-10-23 |
| 1073881041 | Sheila Diller | Pharmacist | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2011-12-06 |
| 1225322324 | Ima Pharmacy Cape Coral | Pharmacy | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2011-06-06 |
| 1407084403 | Linda Lee Simms | Nurse Practitioner | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2009-06-29 |
| 1780823757 | Radiology Associates of Tampa Pa | Radiology | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2009-02-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902462 | Shahida Rafiq | Pharmacist | 1619 Delprado Blvd, Cape Coral, FL 33990 | 2020-11-03 |
| 1386259208 | Hope of Life Medical Supply Corp | Durable Medical Equipment & Medical Supplies | 2328 Hancock Bridge Pkwy 1st Fl Ste 114-e, Cape Coral, FL 33990 | 2020-09-09 |
| 1669001814 | Jamie Lindon Kohl | Specialist/Technologist | 605 Se 13th Ct, Cape Coral, FL 33990 | 2020-04-08 |
| 1548809551 | Medical Risk Solutions | Family Medicine | 1020 Cultural Park Blvd, Cottage #7, Cape Coral, FL 33990 | 2019-12-23 |
| 1013495175 | Sunshine Assisted Living Home Care Facility. | Assisted Living Facility | 1422 Se 23rd Ter., Crape Coral, FL 33990 | 2018-08-01 |
| 1215429279 | Five Star Homecare LLC | Adult Companion | 629 Se 10th Pl, Cape Coral, FL 33990 | 2018-06-05 |
| 1730679192 | Amanda Tiana Bright | Developmental Therapist | 1507 Se 18th St, Cape Coral, FL 33990 | 2018-05-11 |
| 1487170908 | Natalie Diaz | Behavior Technician | 317 Se 16th Place, Cape Coral, FL 33990 | 2017-08-16 |
| 1679097273 | Centro Medico LLC | Clinic/Center | 1425 Viscaya Pkwy Ste 101, Cape Coral, FL 33990 | 2017-07-26 |
| 1629506308 | Besties LLC | Adult Companion | 518 Se 20th Ct, Cape Coral, FL 33990 | 2017-05-25 |
| Find all providers in zip 33990 | ||||
| Taxonomy Code | 207RR0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Rheumatology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558347146 | Nosheen Mazhar | Internal Medicine | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2005-12-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619588654 | Wellness Institute of Miami Inc | Internal Medicine | 14114 Sw 42nd Ter, Miami, FL 33175-3644 | 2020-08-13 |
| 1003465253 | Mpp Infusion Center of Doctor Phillips, LLC | Internal Medicine | 6068 S Apopka Vineland Rd Ste 4, Orlando, FL 32819-4449 | 2019-09-10 |
| 1407408883 | Mpp Infusion Center of Kissimmee, LLC | Internal Medicine | 607 Oak Commons Blvd, Kissimmee, FL 34741-4213 | 2019-07-15 |
| 1811559487 | Mpp Infusion Center of Port St Lucie LLC | Internal Medicine | 525 Nw Lake Whitney Pl Ste 101, Port St Lucie, FL 34986-1605 | 2019-07-03 |
| 1336606383 | Infusion Center of Jacksonville, LLC | Internal Medicine | 11512 Lake Mead Ave Ste 302-303, Jacksonville, FL 32256-9680 | 2019-02-26 |
| 1972069946 | Mid-florida Rheumatology LLC | Internal Medicine | 1743 Park Center Dr Ste 400, Orlando, FL 32835-7621 | 2019-02-14 |
| 1992269468 | Rheumatology Center of Palm Beach Pllc | Internal Medicine | 3918 Via Poinciana Ste 2, Lake Worth, FL 33467-2991 | 2019-01-29 |
| 1598205072 | American Arthritis & Rheumatology Associates LLC | Internal Medicine | 2255 Glades Rd Ste 228w, Boca Raton, FL 33431-7391 | 2017-03-02 |
| 1275904575 | Florida Rheumatology Associates Inc | Internal Medicine | 6801 Us Highway 27 N Ste A2, Sebring, FL 33870-1000 | 2015-10-13 |
| 1033580709 | Brett R. Hutton, M.d., P.a. | Internal Medicine | 10301 Hagen Ranch Rd Ste B550, Boynton Beach, FL 33437 | 2015-10-07 |
| Find all providers with the same taxonomy | ||||
| City | CAPE CORAL |
| Zip Code | 33990 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.