JUSTIN CLARK (NPI# 1538129085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538129085 |
| Entity Type | Individual |
| Full Name | JUSTIN CLARK |
| Credential | D.O. |
| Practice Address |
362 Beal Pkwy Nw Ste 105 Fort Walton Beach FL 32548-3926 |
| Practice Telephone | 8508623020 |
| Practice Fax Number | 8508621363 |
| Mailing Telephone | 8508623020 |
| Mailing Fax Number | 8508621363 |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207K00000X | Allergy & Immunology | OS9224 | FL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 115 Beech Avenue, Crestview, FL 32536 | 8508623020 | 8508621363 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493226 | Justin Clark | Student in an Organized Health Care Education/Training Program | 7337 Wythe Dr, Noblesville, IN 46062-7785 | 2020-10-08 |
| 1942531868 | Justin Clark | Pharmacist | 12050 N Dove Mt Blvd, Marana, AZ 85658 | 2010-01-15 |
| 1750528964 | Justin Liam Clark | Physical Therapist | 102 Fairview Pk Dr, Elmsford, NY 10523-1518 | 2009-01-09 |
| 1598945644 | Justin Charles Clark | Neurological Surgery | 414 Plymouth Ne, Grand Rapids, MI 49505-6041 | 2007-11-06 |
| 1639164098 | Justin Wayne Clark | Dermatology | 3601 22nd St, Lubbock Dermatology, Lubbock, TX 79410-1309 | 2005-09-13 |
| 1619458999 | Justin Blake Clark | Social Worker | 9600 Veterans Dr., Mailstop: Mhc 61-116-c, Tacoma, WA 98493-5000 | 2018-08-24 |
| 1912483645 | Justin D Clark | Social Worker | 533 26th St Ste 100, Ogden, UT 84401-2459 | 2018-07-16 |
| 1235621327 | Justin M Clark | Family Medicine | 1801 Hickman Rd, Des Moines, IA 50314-1505 | 2018-06-04 |
| 1760987481 | Justin Clark | Occupational Therapist | 14151 15 Mile Rd, Sterling Heights, MI 48312-5507 | 2018-03-26 |
| 1285136846 | Justin Clark | Orthotist | 1844 South St, Redding, CA 96001-1809 | 2018-02-28 |
| Street Address |
362 BEAL PKWY NW STE 105 |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32548-3926 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578618104 | All Seasons Allergy and Asthma Center, P.a. | Allergy & Immunology | 362 Beal Pkwy Nw Ste 105, Fort Walton Beach, FL 32548-3926 | 2007-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932718426 | Erica Darby | Pharmacist | Publix, 421 Mary Esther Cut Off, Fort Walton Beach, FL 32548 | 2020-07-30 |
| 1770136681 | Michael Cody Jones | Pharmacist | 251 Miacle Strip Pkwy Se, Fort Walton Beach, FL 32548 | 2019-07-19 |
| 1346714532 | Alison Ann Gould | Occupational Therapy Assistant | Emerald Coast Heath Care, 114 Third St, Fort Walton Beach, FL 32548 | 2019-01-22 |
| 1699217695 | Mayra Lopez | Dentist | Blvd. Gomez Morin #8569, Suite 6a, Juarez, CHIHUAHUA 32548 | 2016-11-08 |
| 1265808455 | Rajiv Tuladhar Dmd Holdings, Pllc | Dentist | 516 Mary Esther Blvd Ste 2, Fort Walton Beach, FL 32548 | 2015-08-11 |
| 1881090702 | Annette Peadro | Behavioral Analyst | 171 Brooks St, Suite 308, Fort Walton Beach, FL 32548 | 2014-11-05 |
| 1790037729 | Julie Bradfield | Counselor | 44 Shell Ave, Fort Walton Beach, FL 32548 | 2012-10-15 |
| 1740559582 | Beth Paula Ritenour | Pharmacist | 414 Mary Esther Cutoff Nw, C, Fort Walton Beach, FL 32548 | 2011-12-23 |
| 1891080867 | Okaloosa County Council On Aging | Home Health | 207 Hospital Drive, Fort Walton Beach, FL 32548 | 2011-06-17 |
| 1649580275 | Sharon Renee Wise | Counselor | 44 Shell Avenue Se, Fort Walton Beach, FL 32548 | 2010-10-17 |
| Find all providers in zip 32548 | ||||
| Taxonomy Code | 207K00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. |
| Notes: Source: American Board of Medical Specialties, 2007, www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Allergy and Immunology, 2007. http://www.abai.org/ No subspecialty certificates in allergy and immunology are offered by the American Board of Allergy and Immunology (ABAI). The ABAI, however, does offer formal special pathways for physicians seeking dual certification in allergy/immunology and pediatric pulmonology; allergy/immunology and pediatric rheumatology; and allergy/immunology and adult rheumatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700878691 | Stephen Richard Boden | Allergy & Immunology | 339 Racetrack Rd Nw Ste 17, Fort Walton Beach, FL 32547-1580 | 2005-08-17 |
| 1578618104 | All Seasons Allergy and Asthma Center, P.a. | Allergy & Immunology | 362 Beal Pkwy Nw Ste 105, Fort Walton Beach, FL 32548-3926 | 2007-01-24 |
| 1649377268 | Geeta Khare | Allergy & Immunology | 339 Racetrack Rd Nw Ste 17, Fort Walton Beach, FL 32547-1580 | 2006-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700419876 | North Star Allergy, Asthma, & Immunology, P.a. | Allergy & Immunology | 900 Carillon Pkwy Ste 301, St Petersburg, FL 33716-1115 | 2020-02-18 |
| 1528604253 | Mark Minor Md Pa | Allergy & Immunology | 2290 W Eau Gallie Blvd Ste 205, Melbourne, FL 32935-3145 | 2019-11-18 |
| 1194366963 | Ami Degala, Pllc | Allergy & Immunology | 40 Forest Ct, Palm Harbor, FL 34683-3811 | 2019-10-03 |
| 1407408586 | Priya Ahya | Allergy & Immunology | 817 S University Dr Ste 106, Plantation, FL 33324-3345 | 2019-07-10 |
| 1770143729 | Melissa Michelle Swertfeger | Allergy & Immunology | 6233 66th St N, Pinellas Park, FL 33781-5025 | 2019-06-20 |
| 1235612771 | Luis Enrique Morera | Allergy & Immunology | 21150 Biscayne Blvd Ste 408, Aventura, FL 33180-1250 | 2018-09-11 |
| 1215417191 | Allergy, Asthma and Immunology Specialists, LLC | Allergy & Immunology | 7100 Camino Real Ste 121, Boca Raton, FL 33433-5510 | 2018-08-20 |
| 1811475213 | Juan Guillermo Angel | Allergy & Immunology | 11880 Sw 40th St Ste 304c, Miami, FL 33175-3574 | 2018-07-30 |
| 1831682814 | Lake Allergy, Asthma and Immunology, Pa | Allergy & Immunology | 1822 Salk Ave, Tavares, FL 32778-4300 | 2018-06-13 |
| 1194191346 | Jo Ridley LLC | Allergy & Immunology | 16372 Hibiscus Rd, Brooksville, FL 34601-4352 | 2015-08-11 |
| Find all providers with the same taxonomy | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32548 |
Please comment or provide details below to improve the information on JUSTIN CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.