Individual provider · Type 1 NPI

Charles S. Clark

Medical Physician Assistant · Jacksonville, FL

NPI number 1780913640 Active

Practice location

Bldg. H 2005 Knight Lane Attn: Medical Staff Services, Navy Medicine Support Command
Jacksonville, FL 92055-0140

Call (858) 361-9254 Map

Mailing address

3986 Shields St
San Diego, CA 92124-3314

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XNone listed

Medical Physician Assistant: Definition to come...

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About NPI 1780913640

Charles S. Clark's National Provider Identifier is 1780913640, issued on Dec 23, 2009. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Jacksonville, FL. The record was last updated on Dec 23, 2009.