MEDICARE: DRS. MCCLOW, CLARK & BERK PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740853845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. MCCLOW, CLARK & BERK PA

Provider Business Mailing Address
First Line	:	PO BOX 161180
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32716-1180
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10503 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6295
Country	:	US
Telephone Number	:	904-450-6680
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARIO REZAEI
Credential	:	MD
Telephone Number	:	904-388-6949

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	08/15/2023

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