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General NPI Number Information
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NPI Number | 1659689982
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Entity Type | Organization
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Legal Business Name | CARLTON K CLARKE M.D., P.A,
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 407 W INTERSTATE 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 | 972-240-8539
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Fax | 972-303-1994
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Provider Business Mailing Address
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Address Line | 407 W INTERSTATE 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 | 972-240-8539
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Fax | 972-303-1994
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CARLTON K. CLARKE
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Credential | M.D., P.A.
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Telephone | 972-240-8539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F0154
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License Number State | TX
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