Provider Demographics
NPI:1336106053
Name:CLARK, JENNIFER JOCELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOCELYN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-832-2344
Mailing Address - Fax:303-832-3721
Practice Address - Street 1:2055 N HIGH ST
Practice Address - Street 2:#340
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5503
Practice Address - Country:US
Practice Address - Phone:303-832-2344
Practice Address - Fax:303-832-3721
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1576302080P0207X
CO459192080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025570100Medicaid
SD1336106053Medicaid
CO75034531Medicaid
NM5326087Medicaid
WY1336106053Medicaid
NM657254089Medicaid
WY125003100Medicaid
SD1336106053Medicaid
COCOA109091Medicare PIN