Provider Demographics
NPI:1982612354
Name:CLARKE, DEREK J (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:J
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1210 KY HIGHWAY 36 E
Mailing Address - Street 2:SUITE G4
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7490
Mailing Address - Country:US
Mailing Address - Phone:859-234-9955
Mailing Address - Fax:859-234-9965
Practice Address - Street 1:1210 KY HIGHWAY 36 E
Practice Address - Street 2:SUITE G4
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7490
Practice Address - Country:US
Practice Address - Phone:859-234-9955
Practice Address - Fax:859-234-9959
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY78903804363LX0001X
KY33944207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1265588990OtherNPI WOMEN'S HEALTH CLINIC
KY1982612354OtherNPI DR. DEREK J CLARKE
KY64339443Medicaid
KY1982612354OtherNPI DR. DEREK J CLARKE
0727001Medicare ID - Type Unspecified