Individual
CLARK WYNN LANGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1718 S HENDERSON BLVD, #8, KILGORE, TX 75662-3566
(903) 983-2110
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L1919
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145221101
—
TX
05
—
145221103
—
TX
01
—
TIN PLUS 093
TRICARE
TX
Enumeration date
02/15/2006
Last updated
10/13/2014
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