Provider Demographics
NPI:1467452649
Name:CLARKE, CARLTON KEITH II (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:KEITH
Last Name:CLARKE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:407 W INTERSTATE 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:972-303-2222
Mailing Address - Fax:972-303-2220
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:972-303-2222
Practice Address - Fax:972-303-2220
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4890207V00000X, 208D00000X, 207Q00000X, 207QA0401X, 207QA0505X, 207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1529026-01Medicaid
H78235Medicare UPIN
TX00548HMedicare ID - Type Unspecified