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Jacob Clark
Medical Physician Assistant in Peoria, Illinois
NPI 1013614304

Jacob Clark is a Medical Physician Assistant based in Mcfarland, IL and is specialized in Medical. Jacob Clark practices in Peoria, IL. The NPI Number for Jacob Clark is 1013614304 and holds a License No. (Illinois).

The current practice location address for Jacob Clark is 530 Ne Glen Oak Ave, Peoria, IL and can be reached out via phone at 309-655-2000.

Location: 530 Ne Glen Oak Ave, Peoria, IL, 53558-9158
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1013614304
Provider Name
Jacob Clark
Credential
Provider Entity Type
Individual
Gender
Male
Address
530 Ne Glen Oak Ave, Peoria, IL, 53558-9158
Phone Number
309-655-2000
Fax Number
Provider Enumeration Date
02/08/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
530 Ne Glen Oak Ave
City
Peoria
State
Illinois
Zip
61637-0001
Phone Number
309-655-2000
Fax Number
person
Provider Business Mailing Address Details
Address
530 Ne Glen Oak Ave
City
Peoria
State
Illinois
Zip
61637-0001
Phone Number
309-655-2000
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
()
Definition
Definition to come...
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