MEDICARE: DR. CAROL BILISTON 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	207P00000X	Emergency Medicine Physician	50290	FL
2	207P00000X	Emergency Medicine Physician	161843	NY
3	207P00000X	Emergency Medicine Physician	MD0000016088	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	204488426	OTHER	NY	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811092752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL BILISTON CLARKE MD

Provider Business Mailing Address
First Line	:	6001 WEBB RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3241
Country	:	US
Telephone Number	:	813-329-6012
Fax Number	:	813-884-9295

Provider Business Practice Location Address
First Line	:	6001 WEBB RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3241
Country	:	US
Telephone Number	:	813-329-6012
Fax Number	:	813-884-9295

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	02/28/2011

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