Provider Demographics
NPI:1124092366
Name:PALLARES, CLARA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:CLARA
Middle Name:ANN
Last Name:PALLARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 BRECKINRIDGE LN
Mailing Address - Street 2:#4E
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2742
Mailing Address - Country:US
Mailing Address - Phone:502-454-5252
Mailing Address - Fax:502-454-5353
Practice Address - Street 1:3101 BRECKINRIDGE LN
Practice Address - Street 2:#4E
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2742
Practice Address - Country:US
Practice Address - Phone:502-454-5252
Practice Address - Fax:502-454-5353
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30532207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000334825OtherANTHEM
KYP00172351Medicare PIN
KY000000334825OtherANTHEM
KY0925901Medicare PIN