JEREMY J CLARK (NPI# 1588717417) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588717417 |
| Entity Type | Individual |
| Full Name | JEREMY J CLARK |
| Credential | M.D. |
| Practice Address |
401 E Chestnut St Suite 410 Louisville KY 40202-5700 |
| Mailing Address |
550 S Jackson St Fl 2 Dept Ob/gyn Att Vicki Masterson Louisville KY 40202-1622 |
| Practice Telephone | 5022715999 |
| Practice Fax Number | 5022715994 |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2008-09-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207VG0400X |
Obstetrics & Gynecology Specialization: Gynecology |
41069 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | ANTHEM - PSC | 000000542980 | 01 |
| HUMANA FOUNDATION | 000001172T | 01 | |
| KY | PASSPORT PCP# - FOUNDATION | 50017315 | 01 |
| KY | 7100013410 | 05 | |
| HUMANA PSC | 000001568F | 01 | |
| IN | 200868450 | 05 | |
| KY | PASSPORT SPECIALITY# -FOUNDATION | 50016302 | 01 |
| AETNA | 7290926 | 01 | |
| KY | ANTHEM FOUNDATION | 000000522820 | 01 |
| KY | PASSPORT SPECIALITY - PSC | 50016301 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982772042 | Jeremy Joseph Clark | Counselor | 71 Centennial Loop Ste A, Eugene, OR 97401-2443 | 2006-11-30 |
| 1356958383 | Jeremy Keith Clark | Marriage & Family Therapist | 1525 Lincoln Ave, Ogden, UT 84404-5638 | 2020-09-24 |
| 1912498338 | Jeremy James Clark | Nurse Practitioner | 1900 S Main St, Findlay, OH 45840 | 2018-05-21 |
| 1003334665 | Jeremy L. Clark | Nurse Practitioner | 985 9th Ave Sw Ste 307, Bessemer, AL 35022-7809 | 2017-09-05 |
| 1952747990 | Jeremy Clark | Counselor | 2086 Commerce Ave, Concord, CA 94520-4902 | 2013-05-17 |
| 1902122443 | Jeremy Dean Clark | Radiology | 3901 W 15th St, Plano, TX 75075-7738 | 2010-04-08 |
| 1073838850 | Jeremy Dustin Clark | Ophthalmology | 301 E Muhammad Ali Blvd, Louisville, KY 40202-1511 | 2010-04-05 |
| 1851551873 | Jeremy Clark | Counselor | 2055 Garrett Way, Ste 1, Pocatello, ID 83201-5100 | 2008-06-12 |
| 1710018395 | Jeremy R Clark | Chiropractor | 100 N Kennedy Blvd, Vandalia, IL 62471-2314 | 2007-03-08 |
| Street Address |
401 E CHESTNUT ST SUITE 410 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40202-5700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205832961 | Janice S Fiechter | Nurse Practitioner | 401 E Chestnut St, Ste, Louisville, KY 40202-5700 | 2005-06-27 |
| 1548871932 | Stephen Andrew Zeller | Occupational Therapist | 401 E Chestnut St, Louisville, KY 40202-5700 | 2020-08-11 |
| 1992266993 | Laura Cordonnier | Student in an Organized Health Care Education/Training Program | 401 E Chestnut St, Louisville, KY 40202-5700 | 2019-03-31 |
| 1902372972 | Shae Daniel Morgan | Audiologist | 401 E Chestnut St, Louisville, KY 40202-5700 | 2018-10-17 |
| 1538699277 | Mary Edith Hill | Nurse Practitioner | 401 E Chestnut St, Louisville, KY 40202 | 2017-06-15 |
| 1578097846 | Christopher Lombardi | Student in an Organized Health Care Education/Training Program | 401 E Chestnut St, Ste. 610, Louisville, KY 40202-5700 | 2017-04-13 |
| 1902352784 | Wasan Amornsang | Dentist | 401 E Chestnut St, Suite 550, Louisville, KY 40202-5700 | 2016-08-31 |
| 1972959617 | Garwen Chen | Psychiatry & Neurology | 401 E Chestnut St, Suite 600, Louisville, KY 40202-5700 | 2016-05-12 |
| 1184088163 | Souzana Alkhouri | Psychiatry & Neurology | 401 E Chestnut St, Suite 610, Louisville, KY 40202-5700 | 2016-04-06 |
| 1144684127 | Linda Webster | Counselor | 401 E Chestnut St, Suite 610, Louisville, KY 40202-5700 | 2016-04-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972129682 | Garvit Chhabra | Student in an Organized Health Care Education/Training Program | 550, South Jackson Street, Acb, Third Floor, Louisville, KY 40202 | 2020-06-18 |
| 1396367009 | Richele Williams | Student in an Organized Health Care Education/Training Program | 201 Abraham Flexner Way Department of Family and Pediac, Suite 690, Louisville, KY 40202 | 2020-05-15 |
| 1942822028 | Ahmed Khaled Saleh | Student in an Organized Health Care Education/Training Program | 500 S Jackson St, Room 305, Louisville, KY 40202 | 2020-05-12 |
| 1457972952 | Mir Ali Raza Talpur | Student in an Organized Health Care Education/Training Program | 401 E Chestnut Street, Suite 600 University of Louisvi, Louisville, KY 40202 | 2020-05-06 |
| 1316575533 | Abigail Hatfield | Student in an Organized Health Care Education/Training Program | Internal Medicine Training Program, 550 South Jackson Street, Acb 3rd Floor, Louisville, KY 40202 | 2020-04-01 |
| 1851929210 | Madison Harmon | Student in an Organized Health Care Education/Training Program | Uofl Department of Emergency Medicine, 530 S. Jackson Street Room C1h17, Louisville, KY 40202 | 2020-03-31 |
| 1184252041 | Marianna Weaver | Student in an Organized Health Care Education/Training Program | 550 South Jackson Street, Acb 3rd Floor, University of Louisville, Louisville, KY 40202 | 2020-03-27 |
| 1700347341 | Charles Jake Sadle | Student in an Organized Health Care Education/Training Program | Office of Medical Education C/o Brittney Luckett, 571 S. Floyd St., Ste. 412, Louisville, KY 40202 | 2019-03-27 |
| 1437616794 | Paladina Health, LLC | Family Medicine | Paladina Health Humana East, 123 E Main Street, Louisville, KY 40202 | 2019-02-22 |
| 1205393568 | Paladina Health, LLC | Family Medicine | Paladina Health Humana West, 500 W Main Street, Louisville, KY 40202 | 2019-02-22 |
| Find all providers in zip 40202 | ||||
| Taxonomy Code | 207VG0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902906092 | George M Kudmani | Obstetrics & Gynecology | 9822 3rd Street Rd, Suite 306, Louisville, KY 40272-2847 | 2006-09-25 |
| 1134147325 | Susan P Hertweck | Obstetrics & Gynecology | 3991 Dutchmans Ln Ste 303, Louisville, KY 40207-4723 | 2006-07-17 |
| 1386617298 | Charles B Shane | Obstetrics & Gynecology | 205 Sycamore Hills Ct, Louisville, KY 40245-5095 | 2006-02-10 |
| 1124011556 | Karen H Reed | Obstetrics & Gynecology | 2355 Poplar Level Rd Ste 304, Louisville, KY 40217-1388 | 2005-08-31 |
| 1306287388 | Maggie L Dwiggins | Obstetrics & Gynecology | 3991 Dutchmans Ln Ste 303, Louisville, KY 40207 | 2013-07-08 |
| 1225303977 | George Kudmani Psc | Obstetrics & Gynecology | 9702 Stonestreet Rd, Suite 306, Louisville, KY 40272-6819 | 2012-03-14 |
| 1255657771 | Lousville Urogynecology Pllc | Obstetrics & Gynecology | 4121 Dutchmans Ln, Suite 401, Louisville, KY 40207-4707 | 2010-04-08 |
| 1861724072 | Donald B Katz Md LLC | Obstetrics & Gynecology | 4121 Dutchmans Ln, Suite 101, Louisville, KY 40207-4707 | 2010-02-12 |
| 1912160797 | Jessica A Shepherd | Obstetrics & Gynecology | 401 E Chestnut St, Suite 410, Louisville, KY 40202-5700 | 2008-07-02 |
| 1215067780 | Charles B Shane Md Psc | Obstetrics & Gynecology | 4001 Kresge Way, Suite 315, Louisville, KY 40207-4640 | 2007-03-06 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40202 |
Please comment or provide details below to improve the information on JEREMY J CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.