Healthcare Provider Details

I. General information

NPI: 1144495136
Provider Name (Legal Business Name): MATTHEW S CLOWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5129 DIXIE HWY SUITE 100
LOUISVILLE KY
40216-1727
US

IV. Provider business mailing address

5129 DIXIE HWY SUITE 100
LOUISVILLE KY
40216-1727
US

V. Phone/Fax

Practice location:
  • Phone: 502-447-8786
  • Fax: 502-447-8623
Mailing address:
  • Phone: 502-447-8786
  • Fax: 502-447-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2013005284
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number46811
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: