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General NPI Number Information
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NPI Number | 1174785042
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Entity Type | Organization
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Legal Business Name | C CLARKE II MD GYN PA
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 407 W I 30
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City | GARLAND
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State | TX
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Zip | 75043-5912
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Country | US
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Telephone | 972-303-2222
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Fax | 972-303-2220
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Provider Business Mailing Address
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Address Line | 3308 PRESTON RD STE 350, PMB 110
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City | PLANO
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State | TX
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Zip | 75093-7453
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Country | US
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Telephone | 972-303-2222
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Fax | 972-303-2220
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Authorized Official
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Title or Position | PHYSICIAN / OWNER
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Name | DR. CARLTON KEITH CLARKE II
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Credential | M.D.
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Telephone | 214-316-0913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | L4890
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License Number State | TX
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