Individual
CLARK DRIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1401 W MAGNOLIA AVE, FT WORTH, TX 76104-4250
(817) 923-2101
(817) 926-1471
Mailing address
1401 W MAGNOLIA AVE, FT WORTH, TX 76104-4250
(817) 923-2101
(817) 926-1471
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
1673
TX
224P00000X
Prosthetist
Primary
1673
TX
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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