Provider Demographics
NPI:1588666242
Name:GRIFFITH, CLARK WELLS (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:WELLS
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:555 REPUBLIC DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5481
Mailing Address - Country:US
Mailing Address - Phone:972-644-2819
Mailing Address - Fax:972-680-2949
Practice Address - Street 1:8160 WALNUT HILL LN
Practice Address - Street 2:SUITE #116
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4339
Practice Address - Country:US
Practice Address - Phone:214-365-1150
Practice Address - Fax:214-363-2477
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF0493207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87T259Medicare ID - Type Unspecified
TXC16319Medicare UPIN