Johnson Jack Clark in Santa Rosa - Internal Medicine
Johnson Jack Clark - NPI 1104976810
Johnson Jack Clark is a Internal Medicine in Santa Rosa, California. Johnson Jack Clark practices all healthcare services and medical treatments related to Internal Medicine. The NPI Number for Johnson Jack Clark is 1104976810. The last update date is 2007-07-08.
Johnson Jack Clark's current location address is 401 Bicentennial Way, Santa Rosa, California. You can contact this provider via phone number 7075714000. The mailing address for Johnson Jack Clark is 401 Bicentennial Way, Santa Rosa, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Johnson Jack Clark |
|---|---|
| Address | 401 Bicentennial Way, Santa Rosa, California |
| Phone Number | 7075714000 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | MD |
NPI Number Detail
| NPI Number | 1104976810 |
|---|---|
| Provider Enumeration Date | 2007-01-12 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 401 Bicentennial Way |
|---|---|
| City | Santa Rosa |
| State | California (CA) |
| Post Code | 954032149 |
| Phone Number | 7075714000 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Internal Medicine |
|---|---|
| Taxonomy | 207R00000X |
| Licence No | G85287 |
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Definition: A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and di |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 00G852870 | CA | -- |
Post Comment/ Review Below
What is the Johnson Jack Clark's unique identification number?
The Johnson Jack Clark has been assigned the NPI (National Provider Identifier) Number 1104976810 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Can you provide the Johnson Jack Clark's physical address?
The Johnson Jack Clark is physically located at 401 Bicentennial Way, in the city of Santa Rosa, CA, with the postal code 954032149.
What is Johnson Jack Clark's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Johnson Jack Clark is Internal Medicine, and the taxonomy classification code that categorizes this area of expertise is 207R00000X.
When did the Johnson Jack Clark receive its 1104976810?
The Johnson Jack Clark was issued its 1104976810 on 2007-01-12, which is the date when the organization was assigned this unique identifier.
When was the information related to Johnson Jack Clark most recently updated or refreshed?
The details pertaining to the Johnson Jack Clark, including its address, specialty, and other relevant information, were last updated or refreshed on 2007-07-08.
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