Provider Demographics
NPI:1205844750
Name:JEAN, CLARK S (MD)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:S
Last Name:JEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N STEPHANIE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6692
Mailing Address - Country:US
Mailing Address - Phone:702-952-3350
Mailing Address - Fax:702-952-3365
Practice Address - Street 1:7445 PEAK DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9011
Practice Address - Country:US
Practice Address - Phone:702-952-2140
Practice Address - Fax:702-952-2147
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10420207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500707Medicaid
NVP00078315OtherRAILROAD MEDICARE
NVP00078315OtherRAILROAD MEDICARE
NVH92689Medicare UPIN