Provider Demographics
NPI:1760457857
Name:CLARK, CHRIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:A
Last Name:CLARK
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 1:5345 N GEORGE BUSH FWY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2767
Mailing Address - Country:US
Mailing Address - Phone:972-495-5888
Mailing Address - Fax:972-495-0588
Practice Address - Street 1:5345 N GEORGE BUSH FWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2767
Practice Address - Country:US
Practice Address - Phone:972-495-5888
Practice Address - Fax:972-495-0588
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7885130OtherAETNA NON-HMO
TX198853701Medicaid
TX0049ENOtherBCBS
TX2356360OtherAETNA HMO
TX8L5174Medicare PIN
TX00661LMedicare ID - Type Unspecified
TX0049ENOtherBCBS
TXP01084441Medicare PIN