James R Clark, PA
Physician Assistant, Medical in Tallahassee, FL. Individual provider (NPI-1).
NPI number1124042478
StatusActive
Last updated in NPPESOct 9, 2014
Details
- NPI
- 1124042478
- Entity type
- Individual (NPI-1)
- Name
- James R Clark
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 27, 2006
- Last updated
- Oct 9, 2014
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | PA1685 | FL | Yes |
Practice location
1300 Medical DrTallahassee, FL 32308-4646
Phone 850-216-0100 · Fax 850-216-0112
Mailing address
1300 Medical DrTallahassee, FL 32308-4646
Phone 850-216-0100 · Fax 850-216-0112
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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