Individual
JEFFREY ALLEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 MEDICAL CENTER DR, LEBANON, NH 03756-1000
(603) 653-0642
Mailing address
1 MEDICAL CENTER DR, LEBANON, NH 03756-1000
(603) 653-0642
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
12254
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010560
—
VT
05
—
30204314
—
NH
Enumeration date
07/06/2006
Last updated
07/26/2011
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