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General NPI Number Information
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NPI Number | 1932182227
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Entity Type | Individual
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Provider Name | ALAN STARK CLELAND M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 14540 OLD SAINT AUGUSTINE RD STE 2317 CREDENTIALING DEPARTMENT
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City | JACKSONVILLE
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State | FL
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Zip | 32258-7418
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Country | US
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Telephone | 904-880-9696
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Fax | 904-390-7452
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Provider Business Mailing Address
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Address Line | PO BOX 746638
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City | ATLANTA
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State | GA
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Zip | 30374-6638
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Country | US
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Telephone | 904-202-2092
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Fax | 904-376-4075
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME90885
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME90885
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License Number State | FL
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