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General NPI Number Information
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NPI Number | 1366804536
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Entity Type | Individual
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Provider Name | BRIAN CLARKE MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 20 MEDICAL VILLAGE DR
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City | EDGEWOOD
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State | KY
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Zip | 41017-5401
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Country | US
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Telephone | 859-578-5880
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Fax | 859-578-5881
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Provider Business Mailing Address
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Address Line | PO BOX 635283
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City | CINCINNATI
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State | OH
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Zip | 45263-5283
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Country | US
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Telephone | 859-578-5880
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Fax | 859-578-5881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 57309
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License Number State | KY
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