Individual provider · Type 1 NPI

Jacob Clark

Medical Physician Assistant · Peoria, IL

NPI number 1013614304 Active

Practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Call (309) 655-2000 Map

Mailing address

4537 Tundra Ln
Mcfarland, WI 53558-9158

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XNone listed

Medical Physician Assistant: Definition to come...

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About NPI 1013614304

Jacob Clark's National Provider Identifier is 1013614304, issued on Feb 8, 2023. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Peoria, IL. The record was last updated on Apr 7, 2023.