Individual
EDWARD DEALLEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 W COLLEGE ST STE LL10, GRAPEVINE, TX 76051-3598
(817) 410-7982
(817) 410-7986
Mailing address
1600 W COLLEGE ST STE LL10, GRAPEVINE, TX 76051-3598
(817) 410-7982
(817) 410-7986
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
K3564
TX
Other
Enumeration date
08/21/2006
Last updated
07/08/2007
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