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General NPI Number Information
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NPI Number | 1053393454
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Entity Type | Individual
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Provider Name | CLARK HARRIS GALBRAITH MD
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Gender | Male
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Dates
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Enumeration Date | 11/19/2005
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3019
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Country | US
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Telephone | 863-680-7000
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Fax | 866-264-8519
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Provider Business Mailing Address
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Address Line | P.O. BOX 95004
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City | LAKELAND
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State | FL
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Zip | 33804-5004
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Country | US
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Telephone | 863-680-7000
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Fax | 863-680-7420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME97745
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 33804
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License Number State | TN
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