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General NPI Number Information
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NPI Number | 1831109743
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Entity Type | Individual
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Provider Name | CLEMENTE V. ZULUETA JR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 95 JACKSON HTS STE 201
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City | JACKSON
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State | KY
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Zip | 41339-6500
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Country | US
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Telephone | 606-693-1078
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Fax | 606-693-1079
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Provider Business Mailing Address
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Address Line | PO BOX 908
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City | JACKSON
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State | KY
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Zip | 41339-0908
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Country | US
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Telephone | 606-693-1078
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Fax | 606-693-1079
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 36207
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License Number State | KY
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