Provider Demographics
NPI:1730677238
Name:CLAPPER, JACOB MARK (PA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:MARK
Last Name:CLAPPER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5053 BIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9702
Mailing Address - Country:US
Mailing Address - Phone:810-923-0505
Mailing Address - Fax:
Practice Address - Street 1:2090 JOLLY RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3996
Practice Address - Country:US
Practice Address - Phone:571-349-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant