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NPI Profile for JONATHAN D CLARK in MUSKOGEE, OK.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Surgical |
363AS0400X | 97 | Physician Assistant |
| NPI Number | 1811308240 |
|
| Status | Active | |
| Credentials | PA-C (Physician Assistant-Certified) | |
| Entity | Individual | |
| Enumeration date | 05/20/2014 | |
| Last updated | 02/28/2023 - About 3 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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JONATHAN D CLARK, PA-C