Individual
HOLLIS J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 S 12TH ST, MURRAY, KY 42071-9303
(270) 759-9200
(270) 759-9966
Mailing address
1000 S 12TH ST, MURRAY, KY 42071-9303
(270) 759-9200
(270) 759-9966
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25837
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050308
ANTHEM PROVIDER NUMBER
KY
01
—
080025697
RAILROAD MC PROVIDER NUM
KY
05
—
64258379
—
KY
Enumeration date
11/11/2005
Last updated
10/16/2015
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