Provider Demographics
NPI:1942641121
Name:CLARKE, JONATHAN PAUL (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 TECHNOLOGY PARK STE 109
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7107
Mailing Address - Country:US
Mailing Address - Phone:407-647-2346
Mailing Address - Fax:407-647-5431
Practice Address - Street 1:525 TECHNOLOGY PARK STE 109
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7107
Practice Address - Country:US
Practice Address - Phone:407-647-2346
Practice Address - Fax:407-647-5431
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RILP02944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine