Individual
DR. JOHN SAMUEL CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
119 LAKE BLUFF DR, BULLARD, TX 75757-9740
(903) 825-1981
(903) 825-3375
Mailing address
PO BOX 10090, TYLER, TX 75711-0090
(903) 825-1981
(903) 825-3375
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
G9082
TX
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
G9082
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110348302
—
TX
Enumeration date
06/16/2005
Last updated
08/12/2008
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