JOHNSON JACK CLARK JR. MD
NPI 1104976810
Internal Medicine in Santa Rosa, CA

Q: What is Johnson Clark's NPI number?

The NPI number for Johnson Clark is 1104976810. It was assigned to this individual provider in the NPPES registry on January 12, 2007.

Q: What is Johnson Clark's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: When was this NPI record last updated?

The NPPES record for Johnson Clark was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 12, 2007

401 BICENTENNIAL WAY, SANTA ROSA, CA 95403(707) 571-4000 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Johnson Jack Clark Jr. Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JOHNSON JACK CLARK JR. MD (NPI 1104976810) is an individual internal medicine provider in Santa Rosa, California, licensed in California (G85287) and active in the NPI registry since January 2007.

NPPES Registry Identity

NPI1104976810

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameJOHNSON JACK CLARK JR.Credential: MD

Location Address401 BICENTENNIAL WAYSanta Rosa, CA 95403-2149

Mailing Address1800 Harrison St Fl 7Oakland, CA 94612-3429 · (510) 625-6262

Phone(707) 571-4000

Sole ProprietorNo

Enumeration DateJanuary 12, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1104976810 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in CA · G85287

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

401 BICENTENNIAL WAY, Santa Rosa, CA 95403

Open in Google Maps ↗

Other Identifiers 3

Medicare UPING96544

Medicare ID-Type Unspecified00G852870

Medicaid00G852870CA

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. JESSICA ANNE RUTLAND R.D.

Dietitian, Registered

401 BICENTENNIAL WAY
SANTA ROSA, CA 95403

Sonoma County (707) 393-4787

KURT FALKENBERG P.T.

Physical Therapist

401 BICENTENNIAL WAY, EAST BUILDING, SUITE 190
SANTA ROSA, CA 95403

Sonoma County (707) 571-3352

DELILAH PATTERSON CRNA

Nurse Anesthetist, Certified Registered

401 BICENTENNIAL WAY
SANTA ROSA, CA 95403

Sonoma County (707) 393-4616

KRISZTINA J. BALAZS MD

Pediatrics

401 BICENTENNIAL WAY
SANTA ROSA, CA 95403

Sonoma County (707) 571-4000

JOHN F. KUNKEL MD

Pathology (Anatomic Pathology)

401 BICENTENNIAL WAY
SANTA ROSA, CA 95403

Sonoma County (707) 571-4000

CRISTINA COREY SCHROEN LCSW

Social Worker (Clinical)

401 BICENTENNIAL WAY
SANTA ROSA, CA 95403

Sonoma County (707) 571-2536

JIE GIOK RAHARDJA PHARMD

Pharmacist

401 BICENTENNIAL WAY
SANTA ROSA, CA 95403

Sonoma County (707) 393-4652

CONOR WILLIAM BOWMAN PHARM.D.

Pharmacist

401 BICENTENNIAL WAY
SANTA ROSA, CA 95403

Sonoma County (818) 522-1238

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Johnson Clark's NPI number?

The NPI number for Johnson Clark is 1104976810. It was assigned to this individual provider in the NPPES registry on January 12, 2007.

Where is Johnson Clark located?

Johnson Clark practices at 401 Bicentennial Way, Santa Rosa, CA 95403. The listed phone number is (707) 571-4000.

What is Johnson Clark's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

When was this NPI record last updated?

The NPPES record for Johnson Clark was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.