Individual
DR. JASON PAUL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5323 HARRY HINES BOULEVARD, DALLAS, TX 75390-7201
(214) 645-2800
(214) 645-2808
Mailing address
P.O. BOX 845347, DALLAS, TX 75284-5347
(214) 645-2800
(214) 645-2808
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
L7690
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
L7690
TX
207RP1001X
Pulmonary Disease Physician
L7690
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179096602
—
TX
05
—
179096603
—
TX
01
—
8S3696
BCBS
TX
Enumeration date
07/12/2006
Last updated
01/23/2013
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