Individual
MARY CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1815 W 6TH AVE, STILLWATER, OK 74074-4202
(405) 743-7300
(405) 743-7398
Mailing address
1815 W 6TH AVE, STILLWATER, OK 74074-4202
(405) 743-7300
(405) 743-7398
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L8314
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730673 01
—
TX
Enumeration date
08/19/2006
Last updated
10/27/2008
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