Provider Demographics
NPI:1548695489
Name:CLARK, JASON S (DVM)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:S
Last Name:CLARK
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 CAPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6332
Mailing Address - Country:US
Mailing Address - Phone:502-266-7007
Mailing Address - Fax:502-266-7375
Practice Address - Street 1:11800 CAPITAL WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6332
Practice Address - Country:US
Practice Address - Phone:502-266-7007
Practice Address - Fax:502-266-7375
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYNS-KY-3276174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian