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General NPI Number Information
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NPI Number | 1346337888
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Entity Type | Individual
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Provider Name | ANNA MARIA LIZAMA CLARK M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 4055 VALLEY VIEW LN
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City | DALLAS
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State | TX
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Zip | 75244-5074
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Country | US
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Telephone | 877-570-9359
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Fax |
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Provider Business Mailing Address
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Address Line | 3740 S LAKE ORLANDO PKWY
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City | ORLANDO
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State | FL
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Zip | 32808-3014
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Country | US
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Telephone | 407-435-2339
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Fax | --
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME71282
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License Number State | FL
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