Clark, Jason E

Clark, Jason E is an sole proprietor health care provider with primary practice located at 4615 Philips Highway , Jacksonville FL 32207-7265. He recently has only one registered license in Agencies / Case Management, which is considered as his primary health care specialty. Clark, Jason E can be contacted via phone (904) 739-7006.

Contact Information

Primary practice address
4615 Philips Highway Jacksonville FL 32207-7265
Phone: (904) 739-7006
Fax: (904) 737-3412
Website:
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Health care specialties

SpecialtyCodeLicense #State
Agencies / Case Management 251B00000X 005491100 Florida

Profile Details

NPI number 1568711513
LBN Legal business name Clark, Jason E
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 6th, 2012
Last updated Sep 6th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568711513 NPPES
Florida MEDICAID 005491100

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