Individual
DR. GORDON MICHAEL CLARK SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4119 EMERSON AVE, DALLAS, TX 75205-1144
(214) 520-0720
(214) 520-0720
Mailing address
4119 EMERSON AVE, DALLAS, TX 75205-1144
(214) 520-0720
(214) 520-0720
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
H6794
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80W0278
—
TX
Enumeration date
02/01/2007
Last updated
07/08/2007
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