MEDICARE: JEFFREY ALAN CLARK DO

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	207X00000X	Orthopaedic Surgery Physician	3304	IA

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	19423	OTHER	IA	WELLMARK INS PLAN
3	421417307E4	OTHER	IA	JOHN DEERE HEALTH INS

General Provider Information

NPI Number	:	1831143601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ALAN CLARK DO

Provider Business Mailing Address
First Line	:	PO BOX 2758
Second Line	:	4150 KIMBALL AVENUE
City	:	WATERLOO
State	:	IA
Zip	:	50704-2758
Country	:	US
Telephone Number	:	319-235-5390
Fax Number	:	319-235-5607

Provider Business Practice Location Address
First Line	:	2351 HUDSON ROAD
Second Line	:	SUITE 001
City	:	CEDAR FALLS
State	:	IA
Zip	:	50614-0001
Country	:	US
Telephone Number	:	319-273-5275
Fax Number	:	319-273-5295

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	02/04/2022

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