Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | L4890 | TX |
N | 207QA0401X | Family Doctor - Addiction Medicine | L4890 | TX |
N | 207QA0505X | Family Doctor - Adult Medicine | L4890 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | L4890 | TX |
N | 207R00000X | Internist | L4890 | TX |
N | 111NI0900X | Internist | L4890 | TX |
Y | 207V00000X | Obstetrician & Gynecologist | L4890 | TX |
N | 208D00000X | General Practice Physician | L4890 | TX |
NPI | 1467452649 |
---|---|
Provider Name | Dr. Carlton Keith Clarke II |
First Address | Garland, TX 75043-5912 |
Second Address | Garland, TX 75043-5912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 01/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1529026-01 | (05) | TX |
H78235 | (02) |