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1902992837
JACK O. CLARK
REXBURG, ID
NPI
1902992837
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207R00000X Internal Medicine
(Licence: ID M-7743)
Enumeration Date
2006-10-05
Last Update Date
2020-04-13
Business Address
JACK O. CLARK M.D.
450 E MAIN ST
REXBURG, ID 83440
Phone number: 208-359-6419
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Mailing Address
JACK O. CLARK M.D.
450 E MAIN ST
REXBURG, ID 83440-2048
Phone number: 208-359-6419
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