Provider Demographics
NPI:1457571192
Name:CLARK, SHARON ELLEN (DO MPH)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ELLEN
Last Name:CLARK
Suffix:
Gender:F
Credentials:DO MPH
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Mailing Address - Street 1:2708 MAPLE BROOK CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-7212
Mailing Address - Country:US
Mailing Address - Phone:817-540-3380
Mailing Address - Fax:817-399-0911
Practice Address - Street 1:2500 LOU MENK DR
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-2828
Practice Address - Country:US
Practice Address - Phone:871-352-2483
Practice Address - Fax:817-352-7192
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG32322083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine