Provider Demographics
NPI:1760755797
Name:JAMES T. CLARK M.D. P.A.
Entity Type:Organization
Organization Name:JAMES T. CLARK M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-595-5522
Mailing Address - Street 1:PO BOX 8146
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-8146
Mailing Address - Country:US
Mailing Address - Phone:903-595-5522
Mailing Address - Fax:903-595-3834
Practice Address - Street 1:1100 E LAKE ST
Practice Address - Street 2:SUITE 330
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3343
Practice Address - Country:US
Practice Address - Phone:903-595-5522
Practice Address - Fax:903-595-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty