Keith Terrill Clark, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

35.058088 Issued in OH

Practice address

400 Broadway St
Cincinnati, OH 45202-3312

Phone

(513) 629-1482

Fax

(513) 629-1711

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437167616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 BROADWAY ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452023312",
            "telephone_number": "513-629-1482",
            "fax_number": "513-629-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 BROADWAY ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452023312",
            "telephone_number": "513-629-1482",
            "fax_number": "513-629-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KEITH",
        "middle_name": "TERRILL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35.058088",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "22095",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Sue Clark, NP
• Jensine Juanita Clark
• Jesse L Clark
• Joshua Michael Clark, MD
• Katherine Elizabeth Clark, M.D.
• Kelly Clark, APRN-CNP
• Kennedy Michele Clark
• Kristal D Clark, CNP
• Kristen Clark, M.S. CCC-SLP
• Krystal Clark

• Emergency Medicine Physician in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Emergency Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.