Provider Demographics
NPI:1235333691
Name:CLARK, CHRISTINE BURNS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:BURNS
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13163 66TH ST.
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1812
Mailing Address - Country:US
Mailing Address - Phone:727-228-7000
Mailing Address - Fax:727-223-3614
Practice Address - Street 1:13163 66TH ST.
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1812
Practice Address - Country:US
Practice Address - Phone:727-228-7000
Practice Address - Fax:727-223-3614
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16773207R00000X, 208000000X
FLME137080207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine