MEDICARE: DR. KHALILAH Q CLARKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	P4038	TX

General Provider Information

NPI Number	:	1093977449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHALILAH Q CLARKE MD

Provider Business Mailing Address
First Line	:	1307 8TH AVE STE 603
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4142
Country	:	US
Telephone Number	:	817-662-7044
Fax Number	:	817-438-1969

Provider Business Practice Location Address
First Line	:	1307 8TH AVE STE 603
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4142
Country	:	US
Telephone Number	:	817-662-7044
Fax Number	:	817-438-1969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	02/18/2026

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