MEDICARE: DR. CLARK WELLS GRIFFITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	F0493	TX

General Provider Information

NPI Number	:	1588666242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARK WELLS GRIFFITH M.D.

Provider Business Mailing Address
First Line	:	555 REPUBLIC DR
Second Line	:	SUITE 460
City	:	PLANO
State	:	TX
Zip	:	75074-5481
Country	:	US
Telephone Number	:	972-644-2819
Fax Number	:	972-680-2949

Provider Business Practice Location Address
First Line	:	8160 WALNUT HILL LN
Second Line	:	SUITE #116
City	:	DALLAS
State	:	TX
Zip	:	75231-4339
Country	:	US
Telephone Number	:	214-365-1150
Fax Number	:	214-363-2477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	02/10/2022

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