Provider Demographics
NPI:1407166614
Name:STEARNS, CLARK HAYDEN (MD)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:HAYDEN
Last Name:STEARNS
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 1:6031 LOST CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3808
Mailing Address - Country:US
Mailing Address - Phone:361-288-3528
Mailing Address - Fax:361-288-3528
Practice Address - Street 1:6031 LOST CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3808
Practice Address - Country:US
Practice Address - Phone:361-288-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE-6633208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1312449Medicaid
00TX44OtherBLUE SHIELD
TX1312449Medicaid