Individual
REBECCA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PA-C
Contact information
Practice address
6565 WEST LOOP S, SUITE 800, BELLAIRE, TX 77401-3500
(713) 661-4383
(713) 661-4346
Mailing address
6565 WEST LOOP S, SUITE 800, BELLAIRE, TX 77401-3500
(713) 661-4383
(713) 661-4346
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
PA02134
TX
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
PA02134
TX
207NP0225X
Pediatric Dermatology Physician
PA02134
TX
207NS0135X
Procedural Dermatology Physician
PA02134
TX
Other
Enumeration date
05/07/2007
Last updated
01/02/2008
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