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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Jeffery Clark | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| Description | Provider Number: 114646700 | [sources] | |||
| First name | Jeffery | [sources] | |||
| Last name | Clark | [sources] | |||
| Sector | General Practice MD | [sources] | |||
| Address | Salt Lake City, UT | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers deemed ineligible to participate in Wyoming's Medicaid program.
United States of America · WDH
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States of America | Wyoming Department of Health | - | |||
| Address | ||
|---|---|---|
| Full address | Country | |
| Salt Lake City, UT | United States of America | |