Provider Demographics
NPI:1841498094
Name:CLARKE, JERMAINE GARNETTE (DO)
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:GARNETTE
Last Name:CLARKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MEDICAL DR STE 240
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6372
Mailing Address - Country:US
Mailing Address - Phone:903-364-4525
Mailing Address - Fax:877-581-1491
Practice Address - Street 1:204 MEDICAL DR STE 240
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6372
Practice Address - Country:US
Practice Address - Phone:903-364-4525
Practice Address - Fax:877-581-1491
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2971207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB158845Medicare PIN
TXTXB158861Medicare PIN
TXTXB158833Medicare PIN