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General NPI Number Information
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NPI Number | 1922456201
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Entity Type | Individual
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Provider Name | DOUGLAS TYLER CLARE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2016
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 820 PRUDENTIAL DR STE 713
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8209
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Country | US
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Telephone | 757-897-8831
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Fax |
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Provider Business Mailing Address
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Address Line | 820 PRUDENTIAL DR STE 713
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8209
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Country | US
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Telephone | 904-396-5682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 140659
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License Number State | FL
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