Provider Demographics
NPI:1841384039
Name:JOHN J. CLARKE, D.P.M.
Entity Type:Organization
Organization Name:JOHN J. CLARKE, D.P.M.
Other - Org Name:JOHN J. CLARKE, D.P.M.,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-332-8105
Mailing Address - Street 1:1900 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2755
Mailing Address - Country:US
Mailing Address - Phone:419-332-8105
Mailing Address - Fax:419-332-8608
Practice Address - Street 1:1900 HAYES AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2755
Practice Address - Country:US
Practice Address - Phone:419-332-8105
Practice Address - Fax:419-332-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1898213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCB9902OtherRAILROAD MEDICARE
OH0166056Medicaid
OH0166056Medicaid
OH9279321Medicare PIN