Provider Demographics
NPI:1659575744
Name:CLARKE, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:70 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4928
Mailing Address - Country:US
Mailing Address - Phone:573-335-6671
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:70 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4928
Practice Address - Country:US
Practice Address - Phone:573-335-6671
Practice Address - Fax:573-339-0083
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2023-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY431262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0511604Medicare PIN