Individual
DR. JEFFREY G CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
425 HIGHWAY 51 N, BROOKHAVEN, MS 39601-2350
(601) 833-5713
(601) 833-1616
Mailing address
425 HIGHWAY 51 N, BROOKHAVEN, MS 39601-2350
(601) 833-5713
(601) 833-1616
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
13241
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00116404
—
MS
Enumeration date
09/22/2006
Last updated
07/08/2007
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