Individual
JENNIE T CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2955
(801) 581-2307
Mailing address
PO BOX 841052, LOS ANGELES, CA 90084-1052
(801) 587-6340
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
9067596-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012886430001
—
PA
Enumeration date
04/14/2006
Last updated
04/22/2026
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