Justin P Clark (NPI# 1538129085, PAC ID# 6800881483) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is ALLERGY/IMMUNOLOGY.
| Nation Provider ID (NPI) | 1538129085 |
| PAC ID by PECOS | 6800881483 |
| Professional Enrollment ID | I20050920000377 |
| Full Name | Justin P Clark |
| Organization Legal Name | ALL SEASONS ALLERGY AND ASTHMA CENTER, P.A. |
| Address |
362 Beal Pkwy Nw Suite 105 Fort Walton Beach FL 32548-3926 |
| Phone Number | 8508623020 |
| Gender | M |
| Credential | DO |
| Medical School | UNIVERSITY OF HEALTH SCIENCES/CHICAGO MEDICAL SCHOOL |
| Graduation Year | 2000 |
| Primary Specialty | ALLERGY/IMMUNOLOGY |
| Secondary Specialties | INTERNAL MEDICINE |
| Group Practice PAC ID | 2264465376 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 100223 | FORT WALTON BEACH MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 362 Beal Pkwy Nw, Suite 105, Fort Walton Beach, FL 32548-3926 | 8508623020 | ALL SEASONS ALLERGY AND ASTHMA CENTER, P.A. |
| Organization Legal Name | ALL SEASONS ALLERGY AND ASTHMA CENTER, P.A. |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Crystal A Bonanni | Physician Assistant | All Seasons Allergy and Asthma Center, P.a. | 362 Beal Pkwy Nw, Suite 105, Fort Walton Beach, FL 32548-3926 |
| Street Address |
362 BEAL PKWY NW SUITE 105 |
| City | FORT WALTON BEACH |
| State | FL |
| Zip | 32548-3926 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Crystal A Bonanni | Physician Assistant | All Seasons Allergy and Asthma Center, P.a. | 362 Beal Pkwy Nw, Suite 105, Fort Walton Beach, FL 32548-3926 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Narendra K Gowda | Internal Medicine | 514 Mary Esther Cutoff Nw, Fort Walton Beach, FL 32548-4025 | |
| Kaitlin J Weeks | Physician Assistant | Quality Urgent Care and Wellness Pl | 514 Mary Esther Cut Off Nw, Fort Walton Beach, FL 32548-4047 |
| Kena M Troupe | Nurse Practitioner | Quality Urgent Care and Wellness Pl | 514 Mary Esther Cut Off Nw, Fort Walton Beach, FL 32548-4047 |
| Stephanie Hengle | Nurse Practitioner | Quality Urgent Care and Wellness Pl | 514 Mary Esther Cut Off Nw, Fort Walton Beach, FL 32548-4047 |
| Brittany P Brock | Physician Assistant | Quality Urgent Care and Wellness Pl | 514 Mary Esther Cut Off Nw, Fort Walton Beach, FL 32548-4047 |
| Judy S Cavazos | Physician Assistant | Quality Urgent Care and Wellness Pl | 514 Mary Esther Cut Off Nw, Fort Walton Beach, FL 32548-4047 |
| Jasmine Ts Pang | Family Practice | Quality Urgent Care and Wellness Pl | 514 Mary Esther Cut Off Nw, Fort Walton Beach, FL 32548-4047 |
| Christopher S Lawton | Diagnostic Radiology | Radiology Regional Center Professional Services LLC | 220 Fliva Ave Nw, Fort Walton Beach, FL 32548-4257 |
| Tara M Otto | Diagnostic Radiology | Radiology Associates of Southwest Louisiana | 220 Fliva Ave Nw, Fort Walton Beach, FL 32548-4257 |
| Brett K Searcey | Diagnostic Radiology | Radiology Regional Center Professional Services LLC | 220 Fliva Ave Nw, Fort Walton Beach, FL 32548-4257 |
| Find all physicians in zip 32548 | |||
| City | FORT WALTON BEACH |
| Zip Code | 32548 |
| Specialty | ALLERGY/IMMUNOLOGY |
| City + Specialty | FORT WALTON BEACH + ALLERGY/IMMUNOLOGY |
Please comment or provide details below to improve the information on Justin P Clark.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.