Individual
DR. JENNIFER LYNN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4945 WILLIAMS DR, GEORGETOWN, TX 78628-2008
(512) 819-0500
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-8800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L6327
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598815-01
—
TX
01
—
1598815-02
CSHCN
TX
01
—
8J9873
BLUE SHIELD
TX
01
—
P00053006
RR/MEDICARE
TX
Enumeration date
03/24/2006
Last updated
01/13/2021
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