Provider Demographics
NPI:1033153192
Name:CLARKE, CARLTON K (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:K
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W I 30
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5912
Mailing Address - Country:US
Mailing Address - Phone:972-240-8539
Mailing Address - Fax:972-303-1994
Practice Address - Street 1:407 W I 30
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5912
Practice Address - Country:US
Practice Address - Phone:972-240-8539
Practice Address - Fax:972-303-1994
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033305601Medicaid
TX1033153192Medicaid
TX1033153192Medicaid
TXC14531Medicare UPIN