Dr. Jeffrey M Clark
Oral and Maxillofacial Surgeon Oral and Maxillofacial Pathology
1802 Rockingham Ave
Bowling Green
, Kentucky 42104-3348
Dr. Jeffrey M Clark
Oral and Maxillofacial Surgeon Oral and Maxillofacial Pathology
1802 Rockingham Ave
Bowling Green
, Kentucky 42104-3348
(270) 901-1997
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About
Features
Specialties
- Oral and Maxillofacial Pathology
- Oral and Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Dr. Jeffrey M Clark
- 1802 Rockingham Ave
- Bowling Green, KY
- Zip : 42104-3348
- Fax : (270) 901-1997
- Phone : (270) 783-0064
Second Address
- Dr. Jeffrey M Clark
- 1802 Rockingham Ave
- Bowling Green, KY
- Zip : 42104-3348
- Fax : (270) 901-1997
- Phone : (270) 783-0064
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 1223P0106X | Oral and Maxillofacial Pathology | 8960 | KY |
| Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8960 | KY |
National Provider Identifier
| NPI | 1649261850 |
|---|---|
| Provider Name | Dr. Jeffrey M Clark |
| First Address | Bowling Green, KY 42104-3348 |
| Second Address | Bowling Green, KY 42104-3348 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 04/11/2005 |
| Last Update Date | 21/09/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 132568 | TRICARE (01) | |
| 3146210 | BCBS TN (01) | TN |
| 702005606 | CARITEN COMMERICAL INSURA (01) | TN |
| U80611 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.