MEDICARE: JERMAINE GARNETTE CLARKE DO

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	207RG0100X	Gastroenterology Physician	P2971	TX

General Provider Information

NPI Number	:	1841498094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERMAINE GARNETTE CLARKE DO

Provider Business Mailing Address
First Line	:	204 MEDICAL DR STE 240
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75092-6372
Country	:	US
Telephone Number	:	903-364-4525
Fax Number	:	877-581-1491

Provider Business Practice Location Address
First Line	:	204 MEDICAL DR STE 240
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75092-6372
Country	:	US
Telephone Number	:	903-364-4525
Fax Number	:	877-581-1491

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	12/08/2019

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