Provider Demographics
NPI:1477754976
Name:CLARK, ANTHONY JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSE
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1899 EIDER CT
Mailing Address - Street 2:KWB PATHOLOGY ASSOC. DISTRICT 2 O.M.E
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4537
Mailing Address - Country:US
Mailing Address - Phone:850-942-7473
Mailing Address - Fax:850-877-0384
Practice Address - Street 1:1899 EIDER CT
Practice Address - Street 2:KWB PATHOLOGY ASSOC. DISTRICT 2 O.M.E
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4537
Practice Address - Country:US
Practice Address - Phone:850-942-7473
Practice Address - Fax:850-877-0384
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA035588207ZF0201X, 207ZP0101X
FLME99459207ZP0101X, 207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology