MEDICARE: JANET E CLARK MD

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	207L00000X	Anesthesiology Physician	ME0067790	FL

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
2	2488479	OTHER	FL	AETNA
3	050079777	OTHER	FL	MCRR
4	51855Z	OTHER	FL	MCR
5	0867335	OTHER	FL	CIGNA
6	51855	OTHER	FL	BSFL

General Provider Information

NPI Number	:	1790774719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET E CLARK MD

Provider Business Mailing Address
First Line	:	3249 SUNSET KEY CIR
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33955-1969
Country	:	US
Telephone Number	:	941-575-9372
Fax Number	:

Provider Business Practice Location Address
First Line	:	3249 SUNSET KEY CIR
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33955-1969
Country	:	US
Telephone Number	:	941-575-9372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	06/15/2012

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Directions to “ JANET E CLARK MD” Practice Location

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