Provider Demographics
NPI:1851409007
Name:CLARK, FRANK C (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:C
Last Name:CLARK
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 1:2 TRILLIUM WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8445
Mailing Address - Country:US
Mailing Address - Phone:606-523-2140
Mailing Address - Fax:606-523-2547
Practice Address - Street 1:TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8445
Practice Address - Country:US
Practice Address - Phone:606-528-1212
Practice Address - Fax:606-523-2547
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36432207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000200592OtherANTHEM
KY64044878Medicaid
KY64044878Medicaid
KY000000200592OtherANTHEM
KY0229016Medicare ID - Type Unspecified
KY0880809Medicare ID - Type Unspecified
KYP00057637Medicare ID - Type UnspecifiedRAILROAD MEDICARE