Individual
BRIAN CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-5401
(859) 578-5880
(859) 578-5881
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 578-5880
(859) 578-5881
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
57309
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21718
MEDICAL LICENSE
HI
01
—
57309
MEDICAL LICENSE
KY
Enumeration date
03/25/2016
Last updated
11/21/2024
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