Individual
DR. CHARLES S CLARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6118 PARKWAY DR., CORPUS CHRISTI, TX 78414-2455
(361) 883-2000
(361) 561-1354
Mailing address
PO BOX 6770, CORPUS CHRISTI, TX 78466-6770
(361) 883-2000
(361) 561-1354
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
D9397
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126242003
—
TX
01
—
200035255
MEDICARE B RAILROAD
TX
Enumeration date
06/09/2005
Last updated
01/30/2014
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