GARY L CLARK (NPI# 1114911328) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114911328 |
| Entity Type | Individual |
| Full Name | GARY L CLARK |
| Credential | PA C |
| Practice Address |
605 Lamar Ave Brooksville FL 34601-3211 |
| Practice Telephone | 3527995411 |
| Practice Fax Number | 3525442713 |
| Mailing Telephone | 3527995411 |
| Mailing Fax Number | 3525442713 |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2014-09-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA2265 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | RAILROAD MEDICARE | 900013195 | 01 |
| FL | 290338500 | 05 | |
| FL | RAILROAD MEDICARE | 970028329 | 01 |
| FL | RAILROAD MEDICARE | 970029323 | 01 |
| FL | BC/BS FL | Y00ZL | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548876048 | Gary Lee Clark | In Home Supportive Care | 71312 Woods Ave, Martins Ferry, OH 43935-3104 | 2020-09-20 |
| 1588085302 | Gary Marvin Clark | Pharmacist | 15227 Aurora Cir, Urbandale, IA 50323-2472 | 2013-12-20 |
| 1487855961 | Gary K. Clark | Dentist | 9730 S 700 E Ste 106, Sandy, UT 84070-4503 | 2007-05-30 |
| 1174649172 | Gary Clark | Social Worker | 502 W 143rd St, Suite 3a, New York, NY 10031-6507 | 2007-03-21 |
| 1912022484 | Gary Mike Clark | Marriage & Family Therapist | 8911 3rd Street Rd, Louisville, KY 40272-2501 | 2007-03-20 |
| 1013987759 | Gary Wayne Clark | Family Medicine | 125 Canton Rd Nw, Carrollton, OH 44615-1009 | 2006-01-25 |
| 1609861152 | Gary W Clark | Podiatrist | 166 W 1325 N, Suite 300, Cedar City, UT 84721-7792 | 2005-09-12 |
| 1972140713 | Gary Clark | Behavior Technician | 100 Spenryn Dr, Madison, AL 35758-1890 | 2019-11-27 |
| 1043514540 | Gary D Clark | Pharmacist | 2701 S Nc 127 Hwy, Hickory, NC 28602-9130 | 2010-12-27 |
| 1902962939 | Gary Bruce Clark | General Practice | 1790 30th St, Suite 230, Boulder, CO 80301-1022 | 2006-12-27 |
| Street Address |
605 LAMAR AVE |
| City | BROOKSVILLE |
| State | FL |
| Zip Code | 34601-3211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508869330 | Anna K Allen | Nurse Practitioner | 605 Lamar Ave, Brooksville, FL 34601-3211 | 2005-05-24 |
| 1336571355 | Verimed Health Group, Brooksville | Clinic/Center | 605 Lamar Ave, Brooksville, FL 34601 | 2013-08-01 |
| 1043331531 | Mukesh B Satodiya | Internal Medicine | 605 Lamar Ave, Brooksville, FL 34601-3211 | 2007-04-02 |
| 1659405173 | Monica Marie Malone | Nurse Practitioner | 605 Lamar Ave, Brooksville, FL 34601-3211 | 2007-03-15 |
| 1134133408 | Eddy Laroche | Family Medicine | 605 Lamar Ave, Brooksville, FL 34601-3211 | 2006-07-29 |
| 1447290952 | Physician Partners Network Pa | General Practice | 605 Lamar Ave, Brooksville, FL 34601-3211 | 2006-06-07 |
| 1144273889 | James R Cummings Md Pa | General Practice | 605 Lamar Ave, Brooksville, FL 34601-3211 | 2006-05-17 |
| 1205820511 | Monte Edwards | Physician Assistant | 605 Lamar Ave, Brooksville, FL 34601-3211 | 2005-09-01 |
| 1861486177 | Malcolm R Fraser | Family Medicine | 605 Lamar Ave, Brooksville, FL 34601-3211 | 2005-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811526643 | Benzer Fl 39 LLC | Pharmacy | 80 Ponca De Leon Blvd, Brooksville, FL 34601 | 2020-04-03 |
| 1245868702 | Karon Elaine Stagg | Specialist/Technologist | 20158 Cortez Blvb, Brookesville, FL 34601 | 2020-03-31 |
| 1699253666 | Shedding Light Counseling 'llc' | Counselor | 24059 Cortez Blvd, Brooksville, FL 34601 | 2018-08-01 |
| 1265952162 | Tysheeca Deandrea Washington | Assistant Behavior Analyst | 1535 Greenbriar Villa Circle, Brooksville, FL 34601 | 2017-06-21 |
| 1386179836 | Andrew Bishay | Emergency Medical Technician, Intermediate | 7284 Broad St, Brooksville, FL 34601 | 2017-04-21 |
| 1265892152 | Ralph Vitola | Pharmacist | 218 S. Broad St., Brooksville, FL 34601 | 2016-03-04 |
| 1689018301 | Nic 4 The Grande Leasing LLC | Assisted Living Facility | 725 Desoto Avenue, Brooksville, FL 34601 | 2013-04-24 |
| 1023301496 | Gerald Warren Springstead | Dentist | 605 W. Jefferson St., Brooksville, FL 34601 | 2011-05-18 |
| 1417280330 | Growing Center Counseling | Counselor | 275 W. Jefferson St., Brooksville, FL 34601 | 2009-09-10 |
| 1073663118 | Jennifer Suiters | Social Worker | 706 Ponce De Leon Blvd, Brooksville, FL 34601 | 2007-01-11 |
| Find all providers in zip 34601 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619954252 | Hernando Emergency Group LLC | Physician Assistant | 55 Ponce De Leon Blvd, Brooksville, FL 34601-3200 | 2005-12-26 |
| 1548776065 | Robert Charles Bardin | Physician Assistant | 11375 Cortez Blvd, Brooksville, FL 34613-5409 | 2017-12-20 |
| 1548589930 | Scott Michael Edwards | Physician Assistant | 12900 Cortez Blvd, Suite 205, Brooksville, FL 34613-6828 | 2010-05-25 |
| 1023241643 | Ashley Kay Johnston | Physician Assistant | 17240 Cortez Blvd, Brooksville, FL 34601-8921 | 2009-08-30 |
| 1134360761 | Bryan T Moynihan | Physician Assistant | 14555 Cortez Blvd, Brooksville, FL 34613-6003 | 2009-03-11 |
| 1518930023 | Joann J Dunsmore | Physician Assistant | 14540 Cortez Blvd, Ste 108, Brooksville, FL 34613-6056 | 2006-02-07 |
| 1205820511 | Monte Edwards | Physician Assistant | 605 Lamar Ave, Brooksville, FL 34601-3211 | 2005-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255931325 | Jonathan Thomas Nusbaum | Physician Assistant | 26160 Angelica Rd, Punta Gorda, FL 33955-1419 | 2020-10-28 |
| 1235738659 | Kevin Marcus Luks | Physician Assistant | 10701 Santa Fe Dr, Hollywood, FL 33026-4955 | 2020-10-19 |
| 1245839521 | Stephanie Clay | Physician Assistant | 3455 Rose Mallow Loop, Oviedo, FL 32766-6648 | 2020-10-19 |
| 1104423755 | Lou Joseph Schneggenburger | Physician Assistant | 10115 Forest Hill Blvd Ste 100, Wellington, FL 33414-6178 | 2020-10-07 |
| 1235744582 | Stephanie Graham | Physician Assistant | 1053 Bernice Rd, Rockledge, FL 32955-2201 | 2020-09-14 |
| 1790399483 | Shyla Imani Kissoon | Physician Assistant | 4830 Nw 7th St, Plantation, FL 33317-1410 | 2020-09-01 |
| 1770193500 | My Physician Online | Physician Assistant | 9540 Nw 23rd St, Coral Springs, FL 33065-4974 | 2020-08-06 |
| 1225647977 | Robert Drew Singleton | Physician Assistant | 17501 Biscayne Blvd Ste 460, Aventura, FL 33160-4806 | 2020-07-29 |
| 1750990974 | Andrea K Webber | Physician Assistant | 8119 Sw State Rd 200, Ocala, FL 34481-3448 | 2020-07-23 |
| 1851919526 | Kyra Panni | Physician Assistant | 3857 Hartwood Ln, Jacksonville, FL 32216-1486 | 2020-07-09 |
| Find all providers with the same taxonomy | ||||
| City | BROOKSVILLE |
| Zip Code | 34601 |
Please comment or provide details below to improve the information on GARY L CLARK.
| 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.