Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack O. Clark, MD

Individual provider Internal Medicine Physician · NPI 1902992837

Jack O. Clark, MD is an Internal Medicine in Rexburg, Idaho. Graduated from Pennsylvania State University College of Medicine in 1999, 27 years ago. Practices with Madison Co Memorial Hospital, a 34-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
27
Trained at
Pennsylvania State University College of Medicine
Licensed in
ID
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

450 E Main St
Rexburg, ID 83440
Phone: (208) 359-6419
Fax: (208) 356-3111
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 166 S 5th St, Montpelier, ID 83254-1557 — (208) 847-1110

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence M-7743 (ID)

Record details

NPI number1902992837
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedOctober 5, 2006
Last updated in NPPESApril 13, 2020
Certification dateApril 13, 2020
Mailing address450 E Main St, Rexburg, ID 83440-2048

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolPENNSYLVANIA STATE UNIVERSITY COLLEGE OF MEDICINE
Graduated 1999 (27 years in practice)
Group practice Madison Co Memorial Hospital — 34 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Rexburg