CHARLES S CLARK NPI 1780913640

NPI Information

  • NPI: 1780913640
  • Provider Name: CHARLES S CLARK
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • Address: BLDG. H 2005 KNIGHT LANE ATTN: MEDICAL STAFF SERVICES
    NAVY MEDICINE SUPPORT COMMAND
    JACKSONVILLE, FL
    ZIP 92055
  • Phone: (858) 361-9254

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NPI Details

Charles S Clark is a medical physician assistant in Jacksonville, FL. Charles S Clark NPI is 1780913640. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

BLDG. H 2005 KNIGHT LANE ATTN: MEDICAL STAFF SERVICES
NAVY MEDICINE SUPPORT COMMAND
JACKSONVILLE, FL
ZIP 92055-140
Phone: (858) 361-9254

The enumeration date for this NPI number is 12/23/2009 and was last updated on 12/23/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedicalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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