Individual
ALAN S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1612 S HENDERSON BLVD, KILGORE, TX 75662-3518
(903) 984-3505
Mailing address
PO BOX 8549, FORT WORTH, TX 76124-0549
(817) 451-4208
(817) 563-3699
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K5489
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002KL
BCBS
TX
Enumeration date
06/07/2006
Last updated
02/05/2008
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