NPI age
19 years
Enumerated 2006-10-05
● Active
Type 1 · Individual
Jack O. Clark, M.D.
Clark is 1 of 5 internal medicine providers in Rexburg and 1 of 504 in Idaho.
Primary specialty
Internal Medicine
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2020-04-13
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 504 active internal medicine providers in Idaho.
NPI age
19 years
↑ 3 yr above median (16 yr)
State licenses
1 state
23% of peers hold multiple states
Subspecialties
0
44% of peers hold subspecialties
NPI lifetime · 2006 → 2026
2006-10Enumerated in NPPES
2006
2026
Where they practice
Practice location
450 E Main St
Rexburg, ID 83440
Mailing address
450 E Main St
Rexburg, ID 834402048
Additional practice locations
1 secondary location on file with NPPES.
Location 2
166 S 5th St, Suite B
Montpelier, ID 832541557
Specialties
-
Internal Medicine PrimaryA 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,...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 10018055 | REGENCE BCBS IDAHO |
| 05 (WY) | 114780300 | |
| 05 (ID) | 80633500 | |
| 01 (ID) | 58289 | BLUE CROSS IDAHO |
| 05 (ID) | 805499200 |
Practice context
Part of a multi-provider practice. 41 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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