Individual
JAMES T. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 E LAKE ST, SUITE 330, TYLER, TX 75701-3343
(903) 595-5522
(903) 595-3834
Mailing address
1100 E LAKE ST, SUITE 330, TYLER, TX 75701-3343
(903) 595-5522
(903) 595-3834
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D3181
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041539337
RAILROAD MEDICARE
TX
05
—
11235461
—
TX
01
—
751477994
TAX ID #
TX
Enumeration date
01/18/2007
Last updated
07/08/2007
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