MEDICARE: CARLTON K CLARKE M.D., P.A,

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	207Q00000X	Family Medicine Physician	F0154	TX

General Provider Information

NPI Number	:	1659689982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLTON K CLARKE M.D., P.A,

Provider Business Mailing Address
First Line	:	407 W INTERSTATE 30
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-5912
Country	:	US
Telephone Number	:	972-240-8539
Fax Number	:	972-303-1994

Provider Business Practice Location Address
First Line	:	407 W INTERSTATE 30
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-5912
Country	:	US
Telephone Number	:	972-240-8539
Fax Number	:	972-303-1994

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CARLTON K. CLARKE
Credential	:	M.D., P.A.
Telephone Number	:	972-240-8539

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	09/21/2010

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