Individual
JOHN R CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1140 LEXINGTON RD, GEORGETOWN, KY 40324-9330
(502) 868-1100
Mailing address
1431 CENTERPOINT BLVD, SUITE 100, KNOXVILLE, TN 37932-1984
(865) 985-7068
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
20185
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64201858
—
KY
Enumeration date
03/06/2007
Last updated
07/08/2007
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