Male or Other

Charles S. Clark

Medical Physician Assistant in Jacksonville, FL(View on Map)

Full Name

Charles S Clark

NPI Number

1780913640

NPI Type

Individual Provider

Gender

Male

Enumeration Date

12/23/2009

Specialties

(Taxonomies)

Code

363AM0700X

Primary Taxonomy

Yes

Contact
Information

Purpose

Mailing
Location

Address

3986 SHIELDS ST
BLDG. H 2005 KNIGHT LANE ATTN: MEDICAL STAFF SERVICES

City

San Diego
Jacksonville

State

CA
FL

Postal Code

92124-3314
92055-0140

Country

US
US

Telephone Number

(858) 361-9254
(858) 361-9254

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 12/23/2009

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