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General NPI Number Information
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NPI Number | 1790828648
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Entity Type | Organization
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Legal Business Name | WILLIAM CLARK MEDICAL GROUP PA
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 133 NORTHPOINT DR
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City | HOUSTON
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State | TX
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Zip | 77060-3207
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Country | US
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Telephone | 281-272-0888
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Fax | 713-695-7765
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Provider Business Mailing Address
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Address Line | PO BOX 670188
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City | HOUSTON
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State | TX
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Zip | 77267-0188
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Country | US
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Telephone | 281-272-0888
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Fax | 281-272-0895
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM D CLARK
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Credential | M.D.
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Telephone | 281-272-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | E4818
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License Number State | TX
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