Provider Demographics
NPI:1093977449
Name:CLARKE, KHALILAH Q (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALILAH
Middle Name:Q
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 W 7TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2569
Mailing Address - Country:US
Mailing Address - Phone:817-662-7044
Mailing Address - Fax:817-438-1969
Practice Address - Street 1:3600 W 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2569
Practice Address - Country:US
Practice Address - Phone:817-662-7044
Practice Address - Fax:817-438-1969
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP40382081S0010X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine