MEDICARE: ROHAN CLARKE MD PA

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	207RG0100X	Gastroenterology Physician	M8608	TX

General Provider Information

NPI Number	:	1467811133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROHAN CLARKE MD PA

Provider Business Mailing Address
First Line	:	PO BOX 1362
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76101-1362
Country	:	US
Telephone Number	:	347-200-1410
Fax Number	:	817-732-8015

Provider Business Practice Location Address
First Line	:	500 THROCKMORTON ST
Second Line	:	3107
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3708
Country	:	US
Telephone Number	:	347-200-1410
Fax Number	:	817-732-8015

Authorized Official
Title or Position	:	OWNER
Name	:	ROHAN COURTNEY CLARKE
Credential	:	MD
Telephone Number	:	347-200-1410

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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