Provider Demographics
NPI:1154485407
Name:CLAROS, JAIME E (KCSA)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:E
Last Name:CLAROS
Suffix:
Gender:M
Credentials:KCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 LINN STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5724
Mailing Address - Country:US
Mailing Address - Phone:502-303-2079
Mailing Address - Fax:877-200-4940
Practice Address - Street 1:9111 LINN STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5724
Practice Address - Country:US
Practice Address - Phone:502-303-2079
Practice Address - Fax:877-200-4940
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA100246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000391737OtherANTHEM