Provider Demographics
NPI:1649421132
Name:CLARK, JASON M (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1234 SE MAGNOLIA EXT
Mailing Address - Street 2:UNIT 1
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3770
Mailing Address - Country:US
Mailing Address - Phone:352-401-1218
Mailing Address - Fax:352-401-1017
Practice Address - Street 1:1234 SE MAGNOLIA EXT
Practice Address - Street 2:UNIT 1
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3770
Practice Address - Country:US
Practice Address - Phone:352-401-1218
Practice Address - Fax:352-401-1017
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2022-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME111874208600000X, 2086S0105X, 2086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007273600Medicaid
FLFU596YMedicare PIN