Provider Demographics
NPI:1720009236
Name:CLARK, DANA GIBBS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:GIBBS
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:BERNICE
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2314 SHADYDALE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-5428
Mailing Address - Country:US
Mailing Address - Phone:178-988-4261
Mailing Address - Fax:817-259-2613
Practice Address - Street 1:2314 SHADYDALE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-5428
Practice Address - Country:US
Practice Address - Phone:178-988-4261
Practice Address - Fax:817-259-2613
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7021174400000X, 207YX0602X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153107101Medicaid
TX153107101Medicaid