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1104976810
JOHNSON JACK CLARK
SANTA ROSA, CA
NPI
1104976810
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207R00000X Internal Medicine
(Licence: CA G85287)
Enumeration Date
2007-01-12
Last Update Date
2007-07-08
Business Address
JOHNSON JACK CLARK MD
401 BICENTENNIAL WAY
SANTA ROSA, CA 95403-2149
Phone number: 707-571-4000
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Mailing Address
JOHNSON JACK CLARK MD
1800 HARRISON ST FL 7
OAKLAND, CA 94612-3429
Phone number: 510-625-6262
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