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Individual

DR. MARILYN K. CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 847408, DALLAS, TX 75284-7408
(254) 724-2111

Taxonomy

Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
J1930
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1056921-01
TX
01
1056921-02
CSHCN
TX
01
660003146
RR/MEDICARE
TX
01
81756Y
BLUE SHIELD
TX
Enumeration date
03/24/2006
Last updated
01/13/2021
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