Individual
DR. ROBERT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1717 PRECINCT LINE RD STE 200B, HURST, TX 76054-3197
(817) 369-3990
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
K7696
TX
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
K7696
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159818704
—
TX
Enumeration date
05/05/2006
Last updated
10/04/2019
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