Organization
BROADWAY I-30 MEDICAL CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLTON K CLARKE MD (MEDICAL DIRECTOR-OWNER)
(214) 803-4516
Entity
Organization
Contact information
Practice address
407 W INTERSTATE 30, GARLAND, TX 75043-5912
(972) 240-8539
(972) 303-1994
Mailing address
407 W INTERSTATE 30, GARLAND, TX 75043-5912
(972) 240-8539
(972) 303-1994
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F0154
TX
207V00000X
Obstetrics & Gynecology Physician
L4890
TX
Other
Enumeration date
07/06/2016
Last updated
07/06/2016
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