Individual
JASON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
290 BIG RUN RD, LEXINGTON, KY 40503-2903
(859) 278-9513
Mailing address
601 DANIELS BR, SITKA, KY 41255-8925
(606) 792-6220
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
01929
NC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
41626
KY
Other
Enumeration date
05/15/2008
Last updated
09/10/2013
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