Individual
DR. JEREMY DUSTIN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 E MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1511
(502) 588-0550
Mailing address
301 E MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1511
(502) 588-0550
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
47098
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2010
Last updated
07/11/2014
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