Individual
JEREMY J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 E CHESTNUT ST, SUITE 410, LOUISVILLE, KY 40202-5700
(502) 271-5999
(502) 271-5994
Mailing address
550 S JACKSON ST FL 2, DEPT OB/GYN ATT VICKI MASTERSON, LOUISVILLE, KY 40202-1622
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
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