Individual
JEREMY J CLARK
Active
Individual
JEREMY J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
41069
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000522820
ANTHEM FOUNDATION
KY
01
—
000000542980
ANTHEM - PSC
KY
01
—
000001172T
HUMANA FOUNDATION
—
01
—
000001568F
HUMANA PSC
—
05
—
200868450
—
IN
01
—
50016301
PASSPORT SPECIALITY - PSC
KY
01
—
50016302
PASSPORT SPECIALITY# -FOUNDATION
KY
01
—
50017315
PASSPORT PCP# - FOUNDATION
KY
05
—
7100013410
—
KY
01
—
7290926
AETNA
—
Enumeration date
01/22/2007
Last updated
11/29/2021
Update your record
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