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General NPI Number Information
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NPI Number | 1417602467
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Entity Type | Organization
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Legal Business Name | DRS. MCCLOW, CLARK & BERK PA
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 2300 PARK AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-5571
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Country | US
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Telephone | 904-215-2580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 161180
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32716-1180
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Country | US
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Telephone | 904-388-6949
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARIO REZAEI
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Credential | MD
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Telephone | 904-388-6949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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