Clark, Jerry A
Clark, Jerry A is an individual health care provider with primary practice located at 722 N Fairfield Rd , Beavercreek OH 45434-5918. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Clark, Jerry A can be contacted via phone (937) 208-7000.Contact Information
Primary practice address
722 N Fairfield Rd
Beavercreek OH 45434-5918
Phone: (937) 208-7000
Fax: (937) 208-7010
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 35.054620 | Ohio |
Profile Details
| NPI number | 1346280005 |
|---|---|
| LBN Legal business name | Clark, Jerry A |
| Credentials | MD, CMD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 8th, 2006 |
| Last updated | Dec 10th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1346280005 | NPPES |
| Ohio | MEDICAID | 0647796 |
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